IRLF 


CO 


>- 


Of 


LIBRARY 

OF    THi: 

UNIVERSITY  OF  CALIFORNIA. 

(  rl  KT   <  )K 


Received 
Accession  No.  $  %  J  7  /    • 


,190 

No. 


NERVOUS  BREAKDOWN 


ITS   CONCOMITANT   EVILS— ITS   PREVENTION 

AND   CURE— A   CORRECT  TECHNIQUE 

OF  LIVING  FOR  BRAIN  WORKERS 


BY 


ALBERT  ABRAMS,    A.M.,   M.  D.,    (Heidelberg)   F.  R.  M.  S, 


SAN  FRANCISCO 

THE  HICKS-JUDD  COMPANY 

Publishers,  23  First  Street 

IQOI 


I. 
INTRODUCTION; 

There  are  many  persons  who  suffer  from  obscure  symptoms 
without  any  evident  cause.  Their  enjoyments  of  pleasure  and 
the  comforts  of  life  cease  and  they  become  indifferent  to  subjects 
which  were  formerly  of  interest  to  them.  Presenting  no  evidence 
of  ill-health,  their  relatives  and  friends  are  unsympathetic  and 
suggest  that  the  patient  go  to  work  or  * '  throw  off  the  imagin- 
ary feeling"  or  "use  more  will  power."  They  run  the 
gamut  of  physicians  who,  finding  them  healthy  in  appearance 
and  physically  sound,  tell  them  "you  are  only  nervous," 
"  there  is  nothing  the  matter  with  you,"  and,  after  a  desultory 
conversation,  dismiss  them  with  a  prescription  for  a  nerve 
tonic.  There  are  physicians,  but  they  are  fortunately  few, 
who  are  inclined  to  regard  symptoms  of  a  vague  nature  as 
imaginary,  or  that  the  individual  thus  suffering  is  a  hypo- 
chondriac. Now  the  term  hypochondriasis,  as  employed  by 
the  physician,  means  a  groundless  fear  of  disease  which  has 
no  real  existence,  but  exists  only  in  the  imagination  of  the 
patient.  Imagination  may  be  responsible  for  a  few  diseases, 
but  I  contend  that  an  imagination  which  can  create  a  disease 
is  in  itself  not  in  a  state  of  health.  ' '  No  one  can  be  a  hypo- 
chondriac at  pleasure, ' '  says  L,avkgne. 

These  unfortunates  are  acutely  susceptible  to  any  imputa- 
tion on  the  honesty  of  their  statements  and,  fearing  that 
none  suffer  as  much  as  themselves,  and  obtaining  no  relief, 
they  gradually  sink  into  the  ''slough  of  despond."  The 
heads  of  such  patients  never  feel  just  right.  Their  sleep  is 
disturbed  and  they  feel  depressed  in  the  morning.  Their 
memory  becomes  defective,  and  they  apprehend  a  loss  of  reason. 
Sexual  disturbances,  indigestion  and  constipation  supervene  to 
add  to  their  misery.  They  show  less  endurance  and  become 
irritable.  There  are  no  objective  signs  of  their  suffering,  for 
their  symptoms  are  wholly  subjective.  Such  cases  have  been 


described  variously  as  hypochondriasis,  nervousness,  brain 
strain,  nervous  waste,  nervous  prostration,  nervous  exhaustion 
and  nervous  breakdown.  Physicians  designate  the  symptoms 
by  the  Latin  word,  NEURASTHENIA,  which  means  nerve 
weakness,  and  the  sufferer  is  called  a  neurasthenic.  It  was 
Beard,  of  New  York,  who,  in  1869,  first  directed  general 
attention  to  a  condition  marked  by  irritable  weakness,  and 
adopted  for  it  the  term  neurasthenia.  In  Europe,  it  was  at 
first  derisively  called  Beard's  disease,  or  the  American  disease, 
and  some  even  referred  to  it  as  Americanitis.  Herbert 
Spencer  regarded  the  trouble  as  essentially  American,  a  view 
which  is  decidedly  incorrect  insomuch  as  it  is  a  disease  of 
the  whole  civilized  world.  Very  often  the  cause  of  neuras- 
thenia may  be  resident  in  some  organ  of  the  body.  It  may 
be  the  sexual  apparatus,  the  nose,  throat,  or  digestive  tract, 
hence  all  neurasthenics  should  willingly  submit  to  a  thorough 
examination  by  their  physician,  for  without  a  removal  of  the 
cause,  all  treatment  will  prove  ineffectual.  The  strides  made 
in  diagnostic  medicine  have  been  enormous,  and  with  the 
wonderful  X-rays  at  our  command,  who  can  gainsay  the 
Biblical  quotation,  "For  there  is  nothing  covered  that  shall 
not  be  revealed,  and  hid  that  shall  not  be  known."  We  have 
medical  as  well  as  social  fads.  To  call  every  disease  with 
nervous  symptoms,  neurasthenia,  is  essentially  wrong. 
Neurasthenia  is  unaccompanied  by  any  tangible  evidence  of 
organic  disease.  Therefore  the  diagnosis  of  neurasthenia  is 
only  warranted,  when,  after  a  systematic  and  thorough  ex- 
amination of  the  body,  no  evidence  of  organic  disease  can  be 
elicited.  A  careful  examination  of  the  bodily  functions  is  a 
tedious  and  painstaking  act,  and  necessitates  considerable  skill 
on  the  part  of  the  physician.  Patients  coming  to  the  physician 
for  advice  and  relief  do  not  understand  this.  They  presume 
that  feeling  the  pulse,  looking  at  the  tongue,  and  tapping  the 
chest  constitute  the  sole  diagnostic  aids  of  the  physician.  The 
real  skill  of  a  medical  man  lies  in  his  diagnosis  of  the  case. 
Diagnosis  is  the  goal  of  a  physician's  erudition,  and  justifies 
the  Latin  aphorism,  "He  who  diagnoses  well,  cures  well." 


The  cure  of  disease  will  always  be  an  important  duty 
of  the  physician,  but  the  trend  of  modern  medicine  is  in  the 
direction  of  preventing  disease.  The  efficiency  of  the  physician 
will  be  greatly  enhanced  when  his  services  to  his  patients 
are  less  intermittent  and  more  constant.  The  public  may  yet 
regard  as  commendable  the  Chinese  custom  of  paying  the 
physician  only  during  the  period  health  is  maintained,  all 
emoluments  ceasing  during  sickness.  There  is  a  well-known 
Italian  epitaph  ' '  I  was  well — wished  to  be  better — read 
medical  books — took  medicine — and  died."  Pope's  maxim, 
"A  little  knowledge  is  a  dangerous  thing,"  pertains  in  all 
cogency  to  matters  medical.  The  most  dangerous  dilettan- 
teism  is  that  of  medicine.  The  object  of  this  brochure  is  to 
inculcate  the  grand  precepts  of  hygiene  whereby  disease  may 
be  prevented.  Any  book  tending  to  make  "  any  man  his  own 
physician"  should  read  "every  man  his  own  executioner." 
Without  an  intelligent  conception  of  disease  by  the  layman 
and  his  hearty  co-operation,  the  physician  finds  much  difficulty 
in  the  rational  treatment  of  his  patient,  and  this  is  especially 
true  of  the  neurasthenic.  Credulity  is  belief  without  reason, 
and  scepticism,  reason  without  belief,  but  all  patients  are 
neither  credulous  nor  sceptics.  Neurasthenia  is  a  demoralizing 
disease,  producing  depression,  irritability  and  unreasonable- 
ness, and  no  disease  warrants  more  fitly  the  remark  of  Johnson, 
"Every  man  is  a  rascal  as  soon  as  he  is  sick."  A  neuras- 
thenic should  never  be  his  own  physician,  for,  like  a  lawyer 
who  conducts  his  own  case,  "he  has  often  a  fool  for  a  client." 
This  little  volume  is  dedicated  to  all  those  who  are  liable  to, 
or  suffer  from  nerve  exhaustion,  with  the  hope  that  it  will 
rescue  the  former  and  help  the  latter  to  recover. 

Southwest  corner  Van  Ness  Avenue  and  California  Street, 

San  Francisco,  Cal. 


II. 

THE   CAUSES   OF   NERVOUS   BREAKDOWN. 

Every  individual  is  endowed  at  birth  with  a  definite 
amount  of  nerve  capital.  The  amount  allotted  to  each 
individual  can  never  be  the  subject  of  computation  ;  some 
have  more,  others  less.  Every  mental  act  leads  to  brain  waste, 
but  there  is  also  repair  of  this  waste,  and  when  this  equilibrium 
of  waste  and  repair  is  maintained,  normal  brain  vigor  continues. 
L,et  this  health  equilibrium  be  disturbed  and  at  once  the 
foundation  is  laid  for  an  irritable  weakness  of  the  entire 
nervous  system.  Neurasthenia  rarely  develops  before  the  age 
of  twenty  or  after  fifty.  It  is  a  nerve  disorder  arising  at  a 
time  of  life  when  the  struggle  for  existence  is  most  pro- 
nounced, a  time  of  life  when  the  greatest  demands  are  made 
on  the  nervous  system,  hence,  a  period  between  the  third 
and  fifth  decades  furnishes  the  greatest  number  of  cases. 
Both  sexes  suffer,  but  not  equally,  the  males  preponderat- 
ing. Extremes  of  climatic  conditions  favor  the  develop- 
ment of  the  disease.  All  races  are  victims.  Hebrews  and 
Slavs  are  susceptible  to  it,  and  the  Scandinavians  in  this 
country  furnish  a  large  contingent.  The  law  of  heredity  does 
assert  itself  most  emphatically  as  a  factor  in  nervous  break- 
down. "The  world  is  beginning  to  perceive,"  says  Galton, 
"  that  the  life  of  each  individual  is,  in  some  real  sense,  a  con- 
tinuation of  the  lives  of  his  ancestors."  Holmes,  the  poet 
physician,  observes  that  "we  are  omnibuses  in  which  all  our 
ancestors  ride. "  ' '  The  Gods  visit  the  sins  of  the  fathers  upon 
the  children." 

NEUROTIC  HEREDITY. — There  are  a  number  of  nervous 
diseases  of  direct  hereditary  character,  transmitted  from  gen- 
eration to  generation.  Aside  from  the  transmission  of  an 
unstable  nervous  system,  there  is  a  law  of  heredity  known  as 
the  law  of  sanguinity.  Two  parents  may  have  normal 
organisms,  and  yet  produce  offspring  with  defective  nervous 


8 

constitutions.  The  perfect  organization  pf  the  progeny  is  the 
result  of  three  factors — the  quality  of  the  germ  ( which  brings 
matter),  the  quality  of  the  sperm  (which  brings  force)  and  the 
suitability  of  the  one  to  the  other.  The  following  are  some  of 
the  laws  of  heredity  : 

1.  The  child  may  inherit  the  attributes  of  either  parent 
solely. 

2.  It  may  inherit  the  qualities  of  one  parent  in  some  res- 
j)ects  and  of  the  other  in  other  respects. 

3.  It  may  inherit  the  father's  attributes  for  one  period 
of  existence  and  the  mother's  for  another. 

4.  Attributes  tend  to  appear   in   the  progeny  about  the 
same  time  of  life  at  which  they  became  manifest  in  the  parents. 

5.  Attributes  of  the  father  tend   to   be  inherited  by  the 
sons  and  of  the  mother  by  the  daughters. 

6.  Attributes  may  be  transmitted  in  latent  form  from  one 
generation  to  another,  to  reappear  in  a  third  or  fourth  or  still 
more  remote  generation — a  phenomenon  called  "  reversion." 

There  is  a  variation  in  the  degree  of  hereditary  taint. 
Thus  neurasthenia  is  not  so  serious  a  heritage  as  epilepsy, 
imbecility  or  insanity.  The  taint  in  a  family  is  greater  the 
larger  number  of  members  afflicted.  The  indications  of  a 
neurotic  heredity,  known  as  stigmata,  may  be  manifested  by 
defects  of  moral  sense,  of  memory,  attention,  will,  or  judg- 
ment. It  is  heredity  which  makes  the  nervous  organization 
so  unstable  as  to  collapse  under  strain. 

The  stigmata  of  the  degenerate  may  be  physical,  psychic 
or  both.  Many  notable  writers  who  have  made  a  psycho- 
anthropologic  study  of  degenerates  do  not  attach  the  same  sig- 
nificance to  physical  stigmata  as  does  L,ombroso.  The  chief 
physical  stigmata  are  :  cranial  and  facial  deviation,  recession 
of  the  lower  jaw,  large  or  small  mouth  and  thick  lips,  abnor- 
mally shaped  and  misplaced  ears,  defective  and  misplaced  teeth 
and  high  palate.  Criminal  anthropologists  find  such  deform- 
ities very  common,  although  there  are  a  class  of  occasional 
criminals  who  show  no  peculiarities,  a  type  called  by  Lombroso 
"the  criminal  man."  Unless  the  physical  stigma  has  attained 
such  a  degree  of  structural  anomaly  as  to  impair  the  normal 


function  of  a  part,  no  great  importance  is  to  be  attached  to  it. 
Some  of  the  psychic  stigmata  are  the  following  :  1 — Precocity 
or  retarded  evolution  of  intellect.  2 — Extreme  changeableness 
and  irritability.  3 — Exaggerated  consciousness  and  a  fanatical 
religious  zeal  or  great  moral  depravity.  4 — Intense  egotism  with 
no  regard  for  the  feeling  of  others.  5— Extravagant  and  cranky 
motives  and  desires.  6— One-sided  talents  and  disproportionate 
development  of  mental  faculties. 

While  recognizing  the  undoubted  influence  of  heredity, 
we  are  inclined  to  go  too  far  in  ascribing  to  Nature  the  many 
inflictions  of  individuals,  for  instead  of  being  "more  sinned 
against  than  sinning,"  it  is  just  the  opposite,  for  man  is  often 
the  victim  of  his  own  vicious  habits.  Ingersoll  was  asked  on 
a  certain  occasion  whether  he  thought  he  could  have  made 
things  better  if  he  had  had  the  creation  of  them.  His  reply 
was  "  I  would  have  made  health  catching  instead  of  disease." 
He  was  unquestionably  wrong,  for  the  gift  of  every  living 
thing  is  usually  health,  and  for  most  diseases  man  is  generally 
to  blame  for  having  violated  at  some  time  or  other  a  natural  law, 
and  transgression  has  brought  the  penalties  with  it.  No  disease 
exemplies  more  aptly  the  Scriptural  text,  "The  way  of  the 
transgressor  is  hard,"  than  does  nervous  exhaustion.  "To  be 
of  any  use  at  all,"  says  Balfour,  "  we  must  put  ourselves  in 
Nature's  place  and  work  as  Nature  works." 

The  immortal  Darwin  says,  "Our  lives  are  but  a  bundle 
of  consequences  ;  our  present  is  but  the  outcome  of  the  past." 
It  is  by  trifling  advantages  momentarily  minute  that  Nature 
either  worsens  or  improves  the  status  of  our  vitality,  and  it  is 
by  securing  these  trifling  advantages  and  turning  them  to  the 
good  of  our  patient  that  vital  declension  is  averted  and  chronic 
ailments  remedied  when  that  is  possible.  A  recent  writer, 
Prof.  Putnam,  introduces  the  personal  equation  as  a  factor  in 
disease,  and  limits  the  responsibility  to  the  individual  and  not 
to  heredity.  He  attempts  to  explode  the  pessimistic  fatalism 
attached  to  heredity  and  assures  us  that  a  just  regard  for  the 
laws  of  hygiene  will  help  to  avert  disease.  He  says  that  "  for- 
tunately for  the  educational  outlook,  the  evidence  has  begun 
to  accumulate  that  a  morbid  inheritance  is  not  the  inevitably 


10 

crushing  and  baneful  thing  that  it  has  been  thought.  We 
come  into  the  world,  each  one  a  being  of  limited  capacity, 
but,  in  other  respects,  free  to  become  what  circumstances  make 
us,  and  responsible,  to  the  extent  of  our  capacity,  for  our  lot. 
We  bring  no  ticket-of-leave  which  stamps  us  as  drunkards  or 
maniacs  on  probation,  but  we  do  bear,  in  the  histories  of  our 
ancestors,  a  certificate  that  hints  by  what  efforts  and  by  what 
avoidances  we  can  make  ourselves  reasonable  successes  in  our 
respective  lines.  There  is  no  original  sin  and  not  even  as  it 
seems  to  me,  original  propensity,  but  only  original  capacity  and 
original  limitation,  and  even  limitation  is  only  another  name 
for  latent  capacity." 

PARESIS — It  is  an  every-day  observation  to  hear  of  men  of 
keen  perception  and  ambition  who  excel  in  zeal  and  energy  as 
business  or  professional  men  falling  victims  to  paresis.  The  slow 
and  earnest  plodder  who  goes  through  life  leisurely  without 
scintillations  of  genius  is  the  man  to  be  truly  envied.  The  am- 
bitious man,  with  limited  nerve  capital  and  no  reserve  force, 
who  lets  loose  his  wings  and  soars  to  lofty  heights,  will  be 
certain  to  emulate  Icarus,  whose  wings  were  composed  of  wax. 
The  predisposing  cause  of  paresis  is  sententiously  expressed  by 
Mickle,  "A  life  absorbed  in  ambitious  projects  with  all  its 
strongest  mental  efforts,  its  long-sustained  anxieties,  deferred 
hopes,  and  straining  expectation."  "It  is  the  pace  which 
kills  ' '  and  '  *  burning  the  candle  at  both  ends ' '  are  popular 
expressions  of  the  same  conditions  which  lead  to  paresis.  To 
the  foregoing  causes  must  be  added  syphilis  and  excess  in  the 
use  of  alcohol.  Statistics  show  that  sixty-five  per  cent  of  all 
paretics  have  had  syphilis.  The  relation  of  syphilis  and  paresis 
is  essentially  this  :  The  poison  of  syphilis  weakens  the  consti- 
tution and  vitiates  the  blood  and  prepares  the  brain  for  its  final 
dissolution  by  exciting  causes  like  alcoholism,  excessive  venery, 
brain  strain  and  excitement.  "  Once  syphilis,  always  syphilis" 
said  the  erudite  Ricord.  Syphilis  is,  however,  a  mild  disease 
with  our  present  methods  of  continuous  treatment.  It  is  only 
when  treatment  has  been  inefficient  or  when  the  individual 
gives  himself  over  to  excesses,  that  the  virulency  of  its  tertiary 
manifestations  is  provoked.  It  behooves  syphilitics,  and  they 


11 

unfortunately  constitute  a  large  proportion  of  our  population, 
to  live  a  life  free  from  the  glittering  promises  of  ambition,  with 
all  its  concomitant  evils,  and  above  all,  to  abstain  from  the  use 
and  abuse  of  alcohol . 

Alcohol  is  responsible  for  at  least  twenty  per  cent  of  all 
cases  oi  paresis. 

OCCUPATION — L,abor  of  whatever  kind  demanding  mental 
or  physical  over-work  will  cause  neurasthenia.  Merchants, 
teachers  and  professional  men  furnish  large  numbers  of  neu- 
rasthenics. 

The  chief  causes  of  neurasthenia  are  mental  overwork  asso- 
ciated with  anxiety,  worry  or  excitement.  To  these  must  be 
added  the  abuse  of  alcohol,  tobacco \  coffee,  tea,  bodily  disorders, 
physiologic  factors  and  moral  causes. 

MENTAL  OVERWORK — Brain  activity  is  always  associated 
with  an  increase  in  the  amount  of  blood  in  the  brain,  hence  it 
frequently  happens  that  brain  workers,  who  pursue  their  intel- 
lectual work  after  meals,  suffer  from  indigestion,  for  the  blood 
so  essential  to  digestion  is  attracted  to  the  brain.  The  greatest 
amount  of  work  that  the  brain  can  do  without  fatigue  is  during 
the  early  morning  hours,  for  sleep  has  served  to  recuperate  a 
fagged  brain.  From  the  early  morning  hours  the  ebb  of  nerve 
force  begins,  attaining  its  maximum  discharge  in  the  middle 
of  the  afternoon,  a  time  when  the  nervously  exhausted  are 
most  weak.  The  evening  meal  temporarily  stimulates  the  brain 
functions,  masking  as  it  were  the  depressed  state  of  the  nervous 
system.  Then  follows  sleep.  This  is  nature's  method  of  regu- 
lating waste  and  repair.  The  brain  worker  requires  more  sleep 
than  the  laborer,  and  if  he  deprives  himself  of  the  requisite 
amount  of  sleep,  he  is  laying  the  foundation  for  a  protracted 
siege  of  nervous  prostration.  Nature's  preventive  and  cure  of 
disease  is  sleep.  The  ancients  spoke  of  sleep  as  the  half  brother 
of  death.  Insomnia  or  sleeplessness  is  the  forerunner  of  severe 
mental  disturbances.  The  truism  "laboring  art  can  never 
ransom  nature  from  her  inaidable  estate,"  can  aptly  be  applied 
to  inspmnia. 


12 

WORRIMENT —  Dr.  H.  C.  Sawyer,  of  San  Francisco,  in 
his  admirable  work  on  "  Nerve  Waste,"  expresses  himself  as 
follows  regarding  worry:  "  If  a  long,  flexible,  finely -tempered 
sword  be  supported  at  its  extremities  and  subjected  to  a  mod- 
erate weight  at  its  middle,  it  will  bend,  and  as  often  as  the 
weight  is  lifted  from  it,  will  fly  back  to  its  natural  shape, 
though  this  act  be  repeated  a  million  times;  if  an  excessive 
weight  be  brought  to  bear  upon  the  steel  it  is  snapped  in 
twain;  if  the  blade  be  subjected  to  the  strain  of  a  lesser  but 
still  too  heavy  weight,  it  will  yet  respond  up  to  a  certain  point 
of  strain ;  if  the  too  heavy  weight  is  maintained  during  months 
and  years,  the  resiliency  and  elasticity  of  the  blade  is  impaired, 
the  sword  becomes  crooked,  inelastic,  lifeless.  So  it  is  with 
human  vitality.  A  man  ma}^  sustain  heavy  day  strain 
throghout  a  long  life,  if  the  succeeding  night  hours  are 
periods  of  true  relaxation.  It  is  the  carrying  of  business  cares 
and  worriments  over  night  that  impairs  the  fiber  of  the  delicate 
and  high  strung  nervous  organization  of  the  nervous  consti- 
tution." 

There  is  a  ' '  Don't  Worry  Society ' '  among  whose  mem- 
bers are  hundreds  of  brain  workers.  An  English  writer 
of  prominence  asserts  that  the  majority  of  people  kill  them- 
selves by  lives  of  indolence  of  mind  and  body.  Mental  inac- 
tivity is  injurious  to  physical  health,  and  it  is  rare  to  find  the 
idler  among  the  list  of  centennarians.  Healthy  brain  activity 
is  essential  to  life  and  iustifies  the  aphorism  that  it  is  not  work 
but  worry  that  kills.  That  enviable  man  whom  nothing  worries 
is  the  kind,  considerate  and  patient  man  whom  we  occasionally 
meet  in  this  busy  world.  The  ill-tempered,  irritable  and 
pessimistic  individual,  with  deranged  digestion,  is  the  man 
with  an  unbalanced  nervous  system  who  has  disregarded  the 
natural  law  of  waste  and  repair.  We  know  but  little  of  the 
changes  undergone  by  the  brain  in  nerve  exhaustion,  although 
investigations  made  on  animals  suggest  many  things  which  are 
applicable  to  the  human  being.  When,  for  instance,  intense 
fatigue  is  induced  in  animals  by  stimulation  with  electricity  or 
by  the  exercise  of  normal  functions  to  the  point  of  exhaustion, 


13 

the  nerve  cells  of  animals  become  altered  in  shape,  and  appear 
shrunken,  and  it  is  only  after  hours  of  rest  that  the  cells 
resume  their  normal  appearance. 

PHYSICAL  OVERWORK — This  results  in  bodily  fatigue, 
which  is  really  fatigue  of  the  nervous  system.  This  fatigue  is 
brought  about  by  the  development  in  the  body  of  poisons 
which  exercise  a  paralyzing  influence  on  the  delicate  nerve 
centers. 

THE  ABUSE  OF  ALCOHOL — One  of  the  greatest  scourges 
of  the  nervous  system  is  alcohol.  Alcohol  in  persons  of  a 
nervous  temperament,  even  when  consumed  in  the  smallest 
amounts,  induces  organic  changes  in  the  nerve  tissues  like 
those  of  old  age.  Alcohol  is  essentially  a  medicine,  and  not 
a  substance  for  habitual  consumption.  The  habitual  use  of 
alcohol  stands  foremost,  after  heredity,  as  a  single  indepen- 
dent cause  of  insanity.  The  psychic  degeneration  of  alcoholism 
is  characteristic,  and  consists  of  gradually  weakening  memory 
and  will,  slowness  of  perception  and  judgment,  loss  of  the 
moral  and  esthetic  sense,  with  paroxysms  of  depression,  anger 
and  irritability.  There  is  no  organ  of  the  body  which  is  not 
implicated  in  chronic  alcoholism,  but  it  is  as  a  nerve  intoxicant 
that  its  most  pernicious  effects  are  manifest.  A  moderate 
indulgence  in  alcoholic  beverages  at  meal  times  is  certainly 
not  harmful  to  persons  active  in  mind  and  body,  but  in  those 
with  a  neurotic  heredity  their  use  is  always  injurious. 

TOBACCO — Tobacco  like  alcohol  is  a  drug.  When  used  in 
moderation  by  those  accustomed  to  its  effects  it  is  generally 
harmless.  Some  are  soothed  by  its  use,  whereas  others  are 
intoxicated.  The  temperament  of  the  individual  is  the  only 
real  index  of  its  action,  for,  "what  is  one  man's  meat  is 
another  man's  poison."  Excessive  smoking  results  in  throat 
irritation,  dyspepsia  and  a  peculiar  affection  of  the  heart  known 
as  the  ' '  tobacco  heart. ' '  Oculists  describe  a  partial  blindness 
known  as  toxic  amblyopia  as  a  result  of  the  excessive  use  of 
tobacco,  yet  when  the  habit  is  discontinued,  vision  is,  as  a 
rule,  restored.  The  cigarette  is  more  dangerous  than  the 
cigar,  not  only  because  it  is  used  to  excess  but  because  the 
smoke  is  inhaled. 


14 

COFFEE,  TEA  AND  COCOA — These  substances  while  not 
essential  are  nevertheless  indispensable  to  many  persons. 
Like  all  luxuries  and  it  is  well  to  specify  them  as  such,  the 
harm  arising  from  their  use  is  the  result  of  overindulgence. 
Taken  in  excess,  they  retard  the  digestion  of  starchy  foods. 
A  single  cup  of  coffee  at  breakfast  must  be  regarded  as  a 
stimulant,  while  taken  at  night  it  is  often  the  cause  of  insom- 
nia. There  is  a  device  known  as  the  ergograph  by  which 
muscle  force  is  measured.  It  has  been  shown  by  the  ergo- 
graph that  coffee  will  increase  muscular  power  and  so  will 
small  doses  of  alcohol,  yet,  when  taken  in  large  quantities, 
they  depress  muscle  vigor.  There  are  .many  nervous  affections 
wholly  attributable  to  tea  and  coffee.  Some  of  the  ill  effects 
of  excessive  coffee  drinking  are,  headache,  palpitation  of  the 
heart,  vertigo  and  confusion  of  the  intellect.  The  most  impor- 
tant signs  from  which  habitual  coffee  drinkers  suffer  are  those 
affecting  the  nervous  system,  which  a  foreign  medical  corre- 
spondent thus  describes : 

"Sleep  disappears,  or  is  accompanied  by  terrifying 
dreams.  In  an  upright  position  the  patient  complains  of  a 
sensation  of  vacuum  in  the  head  and  often  of  vertigo.  At  this 
period  of  the  intoxication  there  is  very  marked  trembling  of 
the  upper  and  lower  limbs,  and  also  fibrillary  trembling  of  the 
lips  that  may  spread  to  all  the  muscles  of  the  face  and  to  the 
tongue.  Painful  cramps  also  make  their  appearance  in  the 
muscular  masses  of  the  calf  and  thigh,  particularly  at  night, 
preventing  sleep." 

Similar  evil  effects  follow  from  the  use  of  too  much  tea. 
And  for  these  reasons  physicians  have  for  a  long  time  warned 
their  patients  against  the  chronic  intoxication  and  other  severe 
ills  incident  to  the  free  use  of  coffee  and  tea  as  beverages. 

BODILY  DISEASES  —  Syphilis  is  an  important  cause. 
There  are  some  persons  who  once  having  contracted  the 
disease,  invariably  interpret  every  bodily  derangement  as  a 
manifestation  of  syphilis.  These  unfortunates  can  however 
be  given  the  positive  assurance,  that  a  case  of  syphilis  properly 
and  continuously  treated  rarely  leads  to  bad  results.  Whenever 
the  nutrition  of  the  body  suffers  from  whatever  cause,  the 
nervous  apparatus  in  some  persons  is  the  first  to  suffer. 


15 

PHYSIOLOGIC  FACTORS — Puberty  in  both  sexes,  and  the 
puerperal  state  and  change  of  life  in  women,  as  well  as  the  tis- 
sue changes  peculiar  to  old  age  {senility},  are  periods  in  life 
when  the  delicate  nervous  system  is  subject  to  excessive  strain 
which  increases  its  vulnerability.  Puberty  takes  place  between 
the  thirteenth  and  twentieth  years,  resulting  in  remarkable 
physical  and  mental  changes.  The  evolution  of  the  sexual 
characters  and  development  of  reproduction,  give  rise  to  en- 
tirely new  sensations  and  powerful  emotions.  In  the  boy,  the 
mind  becomes  occupied  with  emotional,  sentimental,  amatory 
and  fantastic  imaginings,  and  it  is  at  this  time  that  the  vicious 
habit  of  masturbation  is  likely  to  be  formed. 

In  the  piterperal  state,  pregnancy  diminishes  the  vitality  of 
woman,  debilitating  and  weakening  her  entire  system,  thus 
rendering  her  a  prey  to  the  many  disorders  of  nervous  break- 
down. 

The  change  of  life>  known  as  the  menopause,  in  women 
between  the  ages  of  forty  and  fifty,  is  another  period  fraught 
with  mischief  to  the  nervous  system,  and  it  is  rare  to  find  in 
this  period  of  involution  a  woman  who  is  free  from  nervous 
manifestations.  The  disequilibration  associated  with  the  ces- 
sation of  ovulation  and  menstruation  is  a  menace  to  mental 
integrity. 

During  the  senile  period  of  life  the  tissue  involution  is 
likely  to  be  attended  by  numerous  mental  disorders.  A  con- 
spicuous sign  is  loss  of  memory  for  recent  events  and  the 
individuals  interest  becomes  centered  in  his  physical  comforts 
and  needs. 

BRAIN  CHANGES  IN  NEURASTHENIA — Physiologic  experi- 
ments demonstrate  that  in  fatigue  of  the  nervous  system,  the 
nerve  cells,  which  in  health  are  plump,  become  shrunken,  and 
become  restored  to  their  original  shape  and  size  only  after 
prolonged  rest. 

Brain  cells,  when  quite  fresh  and  vigorous,  may  be  likened 
to  small  balloons  inflated  ready  for  an  ascent.  They  are  round 
and  full,  and  when  seen  under  the  microscope  they  give  evi- 
dence of  being  distended.  The  cells  of  the  tired  brain,  on  the 
other  hand,  are  seen  to  be  shrunken,  as  an  air  ball  or  toy 
balloon  from  which  most  of  the  air  or  gas  has  escaped. 


16 

When  our  brains  begin  to  work  after  a  refreshing  rest  or 
sleep  they  are,  says  a  recent  writer,  full  of  nerve  fluid,  which 
the  absorbents  of  the  body  and  brain  have  stored  up  there  like 
bees  fill  their  cornb.  So  soon  as  work  begins,  this  vital  force 
is  sapped  to  meet  the  demands  upon  the  brain,  and  the  process 
that  goes  on  during  the  whole  time  it  is  working  may  be 
described  in  the  following  way: 

Imagine  that  these  cells  are  small  goblets  filled  with 
liquid,  and  that  they  have  a  tiny  stem,  through  which  runs  a 
tube  or  opening;  the  liquid  in  the  goblet  is  drained  by  the 
demands  of  mind  and  body,  and  slowly  trickles  through  the 
opening,  drop  by  drop,  until  either  the  work  ceases  or  the 
goblet  is  exhausted. 

This  latter  condition  is  not  often  reached,  for  the  simple 
reason  that  the  owner  of  the  brain  is  very  much  more  likely  to 
collapse.  When  the  cell  has  yielded  half  its  vital  fluid  you 
begin  to  experience  a  feeling  of  fatigue,  and  if  you  go  on 
drawing  the  contents  of  the  cells  you  are  doing  yourself  injury 
in  a  proportionate  degree,  and  nature  will  make  you  pay  for  it 
in  some  way  or  other. 

But  all  the  cells  are  not  involved  in  any  kind  of  mental 
work,  which  means  that  one  part  of  the  brain  may  be  very 
actively  at  work  while  the  other  is  resting  and  storing  up 
nerve  fluid.  Thus  it  is  that  a  man  suffering  from  brain  fag 
may  leave  his  books  and  go  golfing  or  cycling  and  feel  that  he 
is  really  resting;  other  cells  are  being  called  upon  for  work 
now,  while  the  tired  ones — those  required  for  mental  activity — 
are  enjoying  repose. 

But  it  follows  that  the  part  of  the  brain  which  is  called 
into  activity  for  bodily  exercise  is  now  getting  tired,  while  the 
other  part  of  the  brain  is  still  at  work  to  some  extent,  and  so 
the  whole  of  our  brain  cells  become  fatigued,  and  total  rest  in 
the  shape  of  sleep,  is  absolutely  essential. 


III. 

THE  GENERAL  SYMPTOMS  OF  NERVOUS 
BREAKDOWN. 

GENERAL  SIGNS — These  may  be  divided  into — 1 — motor 
disorders.  2 — sensory  disturbances.  3 — disturbances  of  the  special 
senses. 

MOTOR  DISORDERS — Muscular  fatigue  is  a  constant  sign. 
Effort  in  walking  is  exhausting  and  leads  to  prostration. 
Sustained  effort  is  impossible.  The  slightest  muscular  effort 
is  attended  by  trembling.  So  characteristic  is  this  sign  that 
Lemarcq  found  it  in  85  per  cent  of  neurasthenics.  Some  patients 
complain  of  trembling  knees  and  shaking  hands  or  the  tremor 
only  becomes  evident  in  the  handwriting.  There  may  also 
be  muscular  twitchings  in  the  lips  and  face. 

SENSORY  DISTURBANCES — Headache  is  a  common  sign. 
It  may  be  constantly  present  or  invoked  by  any  mental  or 
muscular  effort  or  some  emotion.  The  headache  is  usually 
confined  at  the  base  of  the  brain  or  it  may  be  located  on  the 
top  or  front  of  the  head  or  at  the  temples.  Some  describe 
the  headache  as  a  heavy  weight  or  constriction  about  the 
head.  Some  describe  the  sensation  of  a  closely  fitting  lead 
cap  on  the  head.  Some  experience  a  heaviness  or  throbbing 
and  a  sensation  as  if  wind  or  water  were  running  under  the 
scalp. 

Backache,  confined  to  the  small  of  the  back  or  ac- 
companied by  pain  running  up  between  the  shoulders  or 
through  the  loins  and  down  the  limbs,  is  a  frequent  sign. 

Spinal  tenderness  is  common,  and  may  be  so  pronounced 
as  to  interfere  with  sitting  or  lying  down.  A  favorite  location 
for  the  tenderness  in  women  is  at  the  extreme  end  of  the  spine. 
There  may  be  sensations  of  hot  flushes,  cold,  numbness, 
stiffness,  soreness,  etc.,  in  any  and  all  parts  of  the  body. 


18 

EYE  SIGNS — An  early  sign  is  a  blurring  of  the  vision 
on  using  the  eyes  for  any  length  of  time  which  may  become 
so  pronounced  that  the  person  becomes  unable  to  perform 
any  work  requiring  the  use  of  the  eyes  for  any  length  of  time. 
Often  the  vision  becomes  veiled  arid  things  look  strange  and 
unreal. 

OTHER  DISORDERS  OF  THE  SPECIAL  SENSES — Abnormal 
ringing,  singing,  whistling  and  roaring  sounds  are  heard 
although  the  hearing  itself  is  never  seriously  impaired.  Taste 
is  often  impaired.  Nothing  tastes  exactly  right  or  there  is  a 
bitter  taste  in  the  mouth  even  when  no  food  is  taken. 


IV. 


THE  SPECIAL  SYMPTOMS  OF  NERVOUS 
BREAKDOWN. 

The  signs  may  be  confined  to  single  organs  like  the  brain, 
heart  or  the  stomach  and  intestines  whereas  in  reality,  they 
are  mere  manifestations  of  a  general  breakdown  of  the  nervous 
system. 

BRAIN  SYMPTOMS — The  capacity  for  mental  work  becomes 
lessened.  Any  mental  effort  is  attended  by  a  sense  of  fatigue 
and  distress.  Fixing  the  attention  on  anything  is  difficult  and 
often  impossible.  There  is  loss  of  Memory.  Ideas  do  not 
occur  with  the  usual  vigor  and  patients  often  affirm  that  "they 
cannot  think  straight."  The  fear  of  insanity  is  common  with 
such  persons.  Attracted  by  their  symptoms,  they  become 
introspective,  misconstrue  their  sensations  and  develop  phobias. 
Becoming  morbidly  self-watchful  they  pass  into  a  condition  of 
hypochondriasis.  It  is  rare  for  the  morbid  fears  to  become 
insane  delusions.  Fear  in  neurasthenics  developes  as  a  result 
of  weakness  and  loss  of  courage.  Some  fear  to  be  alone,  some 
fear  darkness,  others  narrow  or  high  places,  etc.  Some  fear 
dirt  or  infection  by  disease.  A  neurasthenic  recognizes  the 
absuridity  of  his  fears  and  is  able  to  dispel  them  whereas  the 
hypochondriac  regards  such  fears  as  actual  conditions  and  can- 
not be  convinced  to  the  contrary.  Diminished  affection  for  those 
dear  to  him  is  another  sign  which  often  distresses  the  patient. 
He  becomes  irritable,  fault-finding  and  resentful.  He  dreads 
meeting  acquaintances  or  people.  He  approaches  his  daily 
task  with  a  sense  of  weariness.  He  becomes  emotional  and 
lachrymose  on  the  slighest  pretext.  He  recounts  the  history 
of  his  illness  to  everyone  who  will  listen  and  often  seems  to 
delight  in  so  doing.  As  a  rule,  he  regards  the  future  with 
disgust  He  cannot  bear  to  read  the  morning  papers  lest  some 
accident,  murder  or  sudden  death  may  distress  him. 


20 

Sleeplessness  is  one  of  the  earliest  signs.  Sometimes  there 
is  difficulty  in  falling  asleep,  or  the  sleep  is  constantly  dis- 
turbed. Occasionally  the  sleep  is  sound  and  deep,  yet  the 
patient  awakens  in  the  morning  unrefreshed  and  often  feels 
more  depressed  than  upon  retiring.  On  closing  the  eyes  in 
bed,  there  is,  at  times,  sudden  jerking  of  the  legs,  or  a  feeling 
as  of  falling.  When  dreams  disturb  the  sleep,  it  indicates  that 
the  latter  is  not  sound,  but  partial.  In  dreams,  the  brain  is  in 
part  awake  ;  the  will  is  dormant  and  the  imagination  runs  riot 
with  incongruous  and  fantastic  images.  When  many  brain 
centers  are  active,  dreams  are  consistent  and  coherent,  while, 
when  few  centers  are  working,  they  are  unreal  and  extrava- 
gant. Dreams  are  evidence  to  the  physician  of  unsound  sleep. 
The  dreaming  period,  in  health,  rarely  occurs  until  the  time 
for  awaking  approaches.  If  the  dreaming  period  comes  on 
early,  there  is  some  disorder  present  in  the  body  which  retards 
the  complete  rest  of  the  brain.  Attempts  have  been  made  to 
classify  dreams,  but  such  classifications,  from  a  psychologic 
standpoint,  are  purely  arbitrary. 

HEART  SIGNS — Heart  palpitation  is  a  frequent  symptom. 
Palpitation  means  that  the  patient  is  conscious  of  his  heart's 
action.  A  conscious  knowledge  of  any  organ  constitutes  dis- 
ease of  that  organ,  not  necessarily  organic,  but  more  often 
functional  disease.  A  person  with  a  healthy  heart  is  not  con- 
scious that  he  has  such  an  organ.  In  the  mild  forms  of  pal- 
pitation only  a  fluttering  or  sinking  feeling  is  experienced.  In 
the  more  severe  forms,  the  heart  beats  violently  against  the 
chest,  the  arteries  throb  and  the  action  of  the  heart  is  increased 
to  as  many  times  as  150  pulsations  per  minute.  In  nervous 
palpitation,  the  face  becomes  flushed,  and  after  the  attacks, 
large  quantities  of  urine  are  passed.  An  attack  may  last  only 
a  fewjminutes  or  may  continue  for  hours.  Palpitation  is  most 
often  caused  by  some  digestive  disturbance  or  maj^  result  from 
emotions  or  prolonged  muscular  or  mental  efforts. 

Ruskin  has  truly  said :  "  No  great  intellectual  thing  was 
ever  done  by  great  effort ;  a  great  thing  can  only  be  done  by  a 
great  man,  and  he  does  it  without  effort.  The  body's  work 
and  the  head's  work  are  to  be  done  quietly,  and  comparatively 


21 

without  effort.  Neither  limbs  nor  brain  are  ever  to  be  strained 
to  their  utmost ;  that  is  not  the  way  in  which  the  greatest 
quantity  of  work  is  to  be  gotten  out  of  them  ;  they  are  never  to 
be  worked  furiously,  but  with  tranquility  and  constancy.  We 
are  to  follow  the  plough  from  sunrise  to  sunset,  but  not  to  pull 
in  raceboats  at  the  twilight ;  we  shall  get  no  fruit  out  of  that 
kind  of  work — only  disease  of  the  heart. ' ' 

Irregularity  of  the  heart  is  another  sign.  An  evidence  ot 
enfeebled  circulation  is  shown  by  cold  hands  and  feet.  Sudden 
flushings  and  sweats  and  pulsations  of  the  large  artery  of  the 
abdomen  are  exceedingly  frequent  to  the  great  annoyance  of 
the  patient. 

STOMACH  SIGNS — The  more  I  observe  dyspeptics,  the 
more  certain  is  my  conviction  that  nervousness  is  responsible 
for  the  majority  of  cases.  We  are  a  nation  of  dyspeptics 
owing  to  our  ceaseless  and  intense  living  methods.  Repair  is 
not  commensurate  with  waste  and  there  comes  a  time  to  many  of 
us  when  our  functions  must  suffer.  All  the  organs  of  the  body 
in  health  work  harmoniously;  one  is  dependent  on  the  other  for 
the  normal  performance  of  its  work.  If  one  suffers  they  all 
suffer,  yet  some  one  organ,  it  may  be  the  heart,  the  stomach  or 
the  liver,  usually  bears  the  brunt  of  nerve  exhaustion.  Why 
this  is  so,  is  difficult  to  say,  other  than  by  supposing  that  every 
person  like  Achilles  has  some  vulnerable  spot.  Some  persons 
when  they  have  a  "nerve  storm"  center  all  their  abnormal 
sensations  in  the  heart,  others  in  the  stomach,  others  in  the 
head,  etc. 

Nervous  indigestion  is  a  freqent  complication  of  nerve 
strain.  The  appetite  may  be  unimpaired  and  even  voracious. 
At  other  times,  the  mere  thought  of  food  is  repugnant.  Often 
the  food  eaten  lies  like  a  heavy  weight.  The  patient  belches 
and  is  apt  to  bring  up  a  sour  fluid  giving  rise  to  heartburn. 
The  tongue  may  be  perfectly  clean  throughout  the  disturbances 
of  digestion.  The  day  has  waned  when  the  physician,  after 
casting  a  furtive  glance  at  the  tongue,  feeling  the  pulse  and 
asking  a  few  desultory  questions  about  the  stomach,  proceeds 
to  prescribe  what  has  been  facetiously  called  a  "shotgun" 
prescription;  embodying  pepsin  and  acid  to  increase  digestion, 


22 

an  alkali  to  correct  acidity,  a  tonic  to  promote  digestion  and 
a  purgative  to  move  the  bowels.  Such  a  prescription  is  as 
much  a  contradiction  as  the  ' '  whisky  cocktail ' '  described  by 
the  perturbed  Frenchman,  "a  little  whisky  to  make  it  strong,  a 
little  water  to  make  it  weak,  a  little  lemon  to  make  it  sour,  a 
little  sugar  to  make  it  sweet,  and  then  you  say,  here's  to  you, 
and  you  drink  it  yourself."  The  scientific  physician  of  to-day 
takes  nothing  for  granted.  He  places  the  patient  on  a  "  test 
meal"  after  which,  he  withdraws  the  contents  of  the  stomach 
and  subjects  it  to  chemic  analysis.  Having  ascertained  the 
ingredients  of  the  gastric  juice,  he  is  ready  to  fulfil  his  duties 
as  an  up-to-date  practitioner,  and  prescribes  accordingly.  In 
the  majority  of  cases  of  nervous  dyspepsia,  chemic  analysis 
shows  no  anomaly,  and  digestion  is  found  to  have  been  com- 
pleted within  the  normal  time  limit.  The  latter  facts  are  alone 
characteristic  of  nervous  dyspepsia.  Were  the  digestive 
trouble  of  a  nature  other  than  nervous,  there  would  be  decided 
changes  in  the  gastric  juice  and  in  the  character  of  the  digestion, 
It  is  strange  how  soon  nervous  dyspeptics  discover  that  it  is 
not  wise  to  eat  too  much  when  nervous  or  excited,  for  it  is  at 
such  a  time  when  the  gastric  signs  predominate.  Prof. 
Bouchard  has  written  a  learned  treatise  on  "Auto-intoxication 
in  Disease."  He  clearly  shows  that  man  is  constantly  standing 
as  it  were  on  the  brink  of  a  precipice;  every  moment  of  his  life 
he  runs  the  risk  of  being  overpowered  by  poisons  generated 
within  his  system.  The  healthy  and  unhealthy  body  is  a  recep- 
tacle and  a  laboratory  of  poisons.  Self-poisoning  is  only  inhibi- 
ted by  the  activity  of  the  skin,  kidneys  and  bowels.  Now 
these  poisons  are  normally  manufactured  in  our  intestinal 
canal,  and  were  it  not  for  the  action  of  the  bowels,  kidneys  and 
skin,  many  of  us  would  succumb  to  auto-intoxication.  In 
indigestion,  these  poisons  are  generated  by  stagnant  food,  and 
give  rise  to  blood  poisoning. 

Auto-intoxication  from  indigestion  does  not  always  mani- 
fest itself  by  the  classic  signs  of  indigestion,  and  it  is  not  infre- 
quent that  the  physician  fails  to  elicit  from  the  patient  subjec- 
tive evidence  of  indigestion. 


THE  INTESTINAL  SIGNS  —  The  chief  sign  is  consti- 
pation. Torpidity  of  the  bowels  may  run  in  families.  Seden- 
tary habits,  coupled  with  excessive  eating  and  a  disregard 
to  the  call  of  nature  as  well  as  the  character  of  the  food  eaten, 
are  common  causes  of  constipation.  In  neurasthenia  the  mus- 
cular tone  of  the  bowels  suffers  and  it  becomes  incapable  of 
moving  the  fecal  matter  onward  into  the  rectum.  There  are 
some  persons  who  are  persistently  constipated  without  suffering 
any  inconvenience.  A  patient  once  told  me,  in  detailing  his 
symptoms,  that  as  far  as  his  bowels  were  concerned,  they 
were  in  perfect  condition,  as  they  moved  regularly  once  -a 
week.  The  majority  of  persons,  however,  complain  that 
unless  they  have  a  daily  evacuation  they  suffer  from  languor, 
headache,  loss  of  appetite  and  depression.  So  potent  an 
influence  does  a  free  evacuation  have  on  the  condition  of  well 
being  that  even  Voltaire  was  induced  to  write:  "Those  per- 
sons who  are  in  good  position  .  .  .  whose  bowels  are  freed 
by  an  easy  regular  peristaltic  movement  every  morning  as  soon 
as  they  have  breakfasted  .  .  .  those  who  are  ttius  favored  by 
nature  are  mild,  affable,  gracious,  kind.  A  no  from  their 
mouth  comes  with  more  grace  than  a  yes  from  the  mouth  of 
one  that  is  constipated." 

A  recent  German  writer  has  collected  a  large  number  of 
cases  of  neurasthenia  dependent  wholly  on  constipation  and 
the  evil  results  thereof.  He  contends  and  his  contention 
cannot  be  questioned  that  the  bowels  normally  manufacture 
poisons  which,  when  absorbed,  influence  the  delicate  nervous 
system.  Hypochondriacs  are  usually  constipated,  and  so  are 
the  insane.  One  of  my  patients,  who  is  an  habitual  sufferer 
from  constipation  and  has  periodic  nerve  storms,  finds  immedi- 
ate relief  after  taking  a  saline  purgative.  The  physiology  of 
defecation  is  practically  as  follows:  The  fecal  matter  formed 
in  the  large  intestine  sets  up  a  motion  known  as  peristalsis, 
which  moves  the  fecal  mass  through  the  large  bowel,  dropping 
it  into  the  rectum.  At  the  latter  point  "a  call  of  nature" 
takes  place  and  an  evacuation  is  the  result.  If  no  response  is 
made  to  this  "call"  by  the  individual,  whether  through 
laziness  or  attention  to  other  duties,  the  watery  portion  of  ' 


24 

the  fecal  mass  is  absorbed,  passes  into  the  circulation  and 
intoxicates  the  nervous  system.  Persons  who  suffer  from  this 
auto-intoxication  have  a  muddy  skin,  dark  rings  under  the 
eyes,  cold  extremities  and  an  unpleasant  taste  in  the  mouth, 
dark,  offensive  and  insufficient  bowel  movements  and  a  heavy 
urine,  which  leaves  a  deposit  on  standing. 

SECRETORY  DISORDERS — The  urine  is  scant  and  dark,  or 
it  may  be  abundant  and  light  colored.  During  or  after  a 
nerve  storm  it  is  usually  of  the  latter  character.  Often  there 
is  some  bladder  irritation  and  the  urine  is  passed  frequently. 
Perspiration  is  usually  profuse,  especially  after  the  slightest 
mental  or  physical  exertion,  and  the  "  cold,  clammy  hand  " 
is  a  common  condition. 

The  sexual  disorders  will  be  considered  in  the  chapter, 
SPECIAL  FORMS  OF  NEURASTHENIA. 


V. 

THE  GENERAL  TREATMENT  OF  NERVOUS 
BREAKDOWN. 

RELIEF  FOR  MENTAL  OVERWORK — Sleep  is  without 
doubt  the  natural  restorative  of  a  fagged  brain.  The  writer, 
when  suffering  from  brain  tire,  finds  more  relief  by  three  days' 
absolute  rest  in  bed  than  by  a  sojourn  of  two  weeks  in  the 
country  after  the  conventional  manner.  Sleep  is,  however,  a 
restorative  that  cannot  always  be  summoned  at  will.  The 
inventor,  speculator,  student  and  business  man  must  seek  mental 
recreation.  The  brain  worker  who  seeks  diversion  and  does 
so  constrainedly  defeats  the  objects  of  such  diversion.  The 
diversion  adopted  must  be  agreeable.  Travel  is  often  suggest- 
ed as  a  method  of  mental  recreation  but  it  is  often  done  in  such 
a  perfunctory  way  that  the  victim  returns  to  his  habitual 
routine  work  more  exhausted  than  recuperated.  They  may 
change  their  skies  but  not  themselves.  Indulgence  in  extra- 
neous literature,  the  cultivation  of  a  fad,  some  regulated 
exercise  like  golf,  bicycling,  hunting,  etc.,  are  excellent  means 
of  diversion.  Employment  prevents  melancholy — it  is  restful 
to  the  body.  Inaction,  idleness  and  the  constant  pursuit  of 
pleasure,  for  the  sake  of  pleasure,  simply  encourage  prema- 
ture old  age.  Above  all  things  in  seeking  physical  exercise  as 
a  means  of  diversion,  be  sure  to  avoid  physical  overwork. 
Physical  exhaustion  is  naught  else  but  nervous  fatigue,  for 
every  physical  act  is  the  result  of  nervous  energy.  The  limit 
of  physical  exercise  is  fatigue.  Rational  exercise  is  never 
exertion  but  a  gradual  and  progressive  use  of  muscles  diverting 
the  blood  from  the  overtaxed  brain  throughout  the  entire  body. 
Neurasthenics  who  overexercise,  develop  poisons  equally  as 
injurious  as  those  generated  by  brain  strain. 

RELIEF  FOR  WORRIMENT— "  Worry,  not  work,  kills." 
Worry  in  persons  previously  unaccustomed  to  great  respon- 
sibilities is  one  of  the  greatest  factors  in  the  premature  loss  of 


26 

health  and  life.  Worry,  grief,  passion  and  fretting  are  power- 
ful nervous  shocks.  They  arrest  the  functions  of  digestion  and 
impair  the  bodily  functions.  Self -control  is  the  palladium  against 
nervous  prostration.  I  have  never  met  nervous  prostration 
in  individuals  who  have  acquired  a  knowledge  of  self-govern- 
ment. We  are  all  competent  to  construct  for  ourselves  a 
philosophy  of  complacency.  Such  philosophy  need  not  resolve 
itself  into  indolence  and  apathy  nor  need  it  assume  the  aspects 
of  stoicism.  When  misfortune  or  disaster  overtakes  the  Turk 
he  attributes  it  to  the  will  of  God  or  more  often  to  fate  {Kismet ) 
and  he  piously  ejaculates:  "  It  is  fate  {Kismet  dir)  or  God  will 
provide"  (Allahkerim).  The  cultivation  of  some  belief  which 
inculcates  the  doctrines  of  contentment  should  be  encouraged. 
It  may  be  a  difficult  matter  to  control  the  emotions  but 
mastery  can  be  attained  by  training.  I  know  many  neuras- 
thenics who  suffer  relapses  whenever  exposed  to  some  intense 
emotion.  When  self-control  is  difficult,  individuals  must  avoid 
conditions  which  introduce  them  to  such  influences.  They 
must  avoid  going  to  funerals,  reading  death  notices  and  the 
newspapers,  cultivate  the  companionship  of  people  who  may 
dream  of  unhappiness  but  wake  up  laughing.  The  worries  of 
some  people  are  often  so  ridiculous  that  they  must  be  regarded 
as  the  emanations  of  a  diseased  mind.  I  know  one  woman, 
who,  after  a  rest  cure  for  nervous  prostration,  suffered  only  one 
inconvenience  and  that  was,  that  she  had  heard  that  recovery 
from  a  "rest cure"  lasted  only  five  years,  and  at  the  end  of 
that  time  she  feared  she  would  suffer  a  relapse.  My  patient 
was  very  much  like  the  woman  whose  doctor  asked  after  her 
health  replied  dolefully:  "I  feel  very  well;  but  I  always  feel 
bad  when  I  feel  well,  because  I  know  I  am  going  to  feel  worse 
afterward. ' ' 

ELIMINATION  OF  FACTORS  CONDUCIVE  TO  NEURASTHE- 
NIA— Knowing  that  the  perennial  unrest  of  body  and  mind, 
continuous  emotional  excitement  like  grief,  worry  and  anxiety, 
make  up  the  causative  elements  of  nerve  waste,  our  primary 
object  is  to  eliminate  the  cause.  We  must  guard  ourselves 
from  drifting  upon  the  shoals  of  nervous  degradation.  Re- 
member that  when  nervous  breakdown  once  occurs,  recovery  is 


27 

only  possible  to  a  certain  extent,  and  relapses  are  frequent.  As 
Courtney  puts  it :  * '  Hardly  any  of  them  come  out  of  the  con- 
flict unscathed,  and  though  many  recover  sufficiently  to  cope 
with  the  ordinary  duties  and  trials  of  life,  they  are  never  quite 
capable  of  weathering  its  real  storms." 

THE  REST  CURE — In  a  little  book,  ' '  Fat  and  Blood  and 
How  to  Make  Them,"  Dr.  Weir  Mitchell  has  created  a  new  era 
in  curative  medicine,  and  the  victims  of  nervous  prostration 
and  hysteria  are  his  debtors.  He  has  simplified  a  task  here- 
tofore almost  impossible  of  attainment,  viz  :  the  cure  of  a  pro- 
nounced case  of  nervous  prostration.  It  would  be  ridiculous 
to  affirm  that  all  cases  can  be  cured  by  the  rest  cure,  any  more 
than  to  say  that  any  method  of  treatment,  yet  devised,  will 
cure  all  cases  of  the  disease  to  which  it  is  adapted.  This  much 
one  can  conscientiously  and  conservatively  say — it  cures  and 
benefits  a  greater  percentage  of  cases  than  any  other  known 
method  of  treatment.  The  cardinal  points  of  the  rest  cure  are 
isolation  of  the  patient,  rest  with  exercise  and  over-feeding.  A 
rest  cure  attempted  at  the  patient's  home  is  rarely  attended 
with  success,  hence  the  necessity  of  absolute  isolation  that  is, 
the  execution  of  the  cure  away  from  home  to  obtain  the 
necessary  control  of  the  patient.  The  most  important  element 
of  treatment  is  moral  control.  Loving  and  sympathetic  rela- 
tives can  never  appreciate  the  nature  of  the  patient's  symp- 
toms. There  are  some  patients  who  thrive  poorly  on  absolute 
isolation,  in  which  instances  they  are  occasionally  permitted  to 
see  at  intervals  their  friends  and  members  of  their  family.  An 
intelligent  nurse  is  indispensable — a  poor  nurse  is  worse  than 
useless.  The  details  of  the  method  are  essentially  as  follows  : 
The  patient  is  confined  to  bed,  and  under  no  circumstance  is 
allowed  to  get  up,  to  read,  or  write.  The  patient  is  even  fed 
by  the  nurse,  the  object  being  to  secure  perfect  passivity  of 
mind  and  body.  Absolute  rest  is  not  always  enforced,  the 
method  being  modified  to  suit  the  individual  case.  It  is  the 
rule  for  patients  to  affirm  that  it  is  impossible  for  them  to  re- 
main in  bed  continuously,  and  it  is  but  natural  that  they 
should  make  this  statement,  for  their  extreme  restlessness  only 
announces  the  instability  of  their  nervous  system.  Contrary 


28 

evidence  is  soon  forthcoming  after  absolute  rest  in  bed  and  the 
manifestations  of  nerve  irritability  are  subdued.  It  is  then 
that  they  share  the  enthusiasm  of  the  poet  when  they  pro- 
claim: "  O  bed  !  O  bed  !  delicious  bed  !  That  heaven  upon 
earth  to  the  weary  head  !" 

After  rest  in  bed  for  several  weeks  the  patient  is  allowed 
to  sit  up.  To  facilitate  digestion  and  build  up  nutrition  during 
the  rest  cure,  massage  and  electricity  are  employed  daily. 
Massage  and  electricity  give  exercise  to  the  unused  muscles, 
improve  the  circulation  and  promote  the  absorption  of 
nourishment.  Insomuch,  as  all  neurasthenics  suffer  from  in- 
digestion, and  consequently  imperfect  body  nourishment,  diet 
is  a  most  important  factor  in  the  rest  treatment.  Great  dis- 
cretion is  exercised  by  the  physician  in  the  selection  of  the 
proper  diet,  and  when  this  is  accomplished,  it  is  surprising 
what  prodigious  quantities  of  food  can  be  taken  by  the  patient 
undergoing  the  rest  cure.  The  improvement  in  nutrition  is 
manifested  by  increase  in  weight  which  may  be  all  the  way 
from  10  to  40  pounds.  In  many  individuals  hydropathic  treat- 
ment is  employed  with  water  of  varying  degress  of  temperature, 
and  it  is  surprising  to  note  the  sedative  and  tonic  influences  of 
cold  water  when  the  patient  is  accustomed  to  its  use.  Of  late, 
hypnotism  or  treatment  by  suggestion  has  been  employed  in  the 
treatment  of  neurasthenia,  and  it  must  be  confessed  that  its  in- 
telligent employment  is  capable  of  marvelous  effects  in  ridding 
the  patient  of  morbid  ideas  and  in  inducing  sleep,  which,  even 
with  drugs,  is  often  times  impossible. 

Healthy  suggestions  made  by  the  physician,  I  regard  as 
indispensable  in  the  treatment  of  many  cases.  The  dangers  of 
hypnotism  are  exaggerated,  for  no  one  can  be  hypnotized 
against  his  wish.  Prof.  Bernheim,  the  apostle  of  hypnotism, 
has  this  to  say  :  ' '  It  is  the  duty  of  the  physician  to  select 
what  is  useful  in  suggestion,  and  to  apply  it  for  the  benefit  of 
his  patients.  When,  in  the  presence  of  sickness,  I  think  that 
therapeutic  suggestion  has  a  chance  of  success,  I  should  con- 
sider myself  to  blame,  as  a  physician,  if  I  did  not  propose  it  to 
my  patient,  and  if  I  did  not  even  make  a  point  of  getting  his 
consent  to  its  employment."  The  influence  of  mind  on  body 


29 

is  every  day  illustrated  by  the  introduction  of  some  new  fad  or 
delusion  in  the  treatment  of  disease.  It  is  difficult  to  conceive 
that  such  results  are  effected  by  the  mind  as  a  simple  thinking 
organ;  on  the  contrary,  the  mind  must  be  regarded  as  a  force 
like  light,  heat  and  electricity  which  operates  for  good  or  evil  on 
the  bodily  functions.  Strong  mental  impressions  may  actuate 
disease,  and  even  death,  or  they  may  act  by  curing  disease. 
Joy  and  hope  stimulate,  whereas  grief  and  despair  depress 
the  bodily  functions.  Sutton,  a  recent  writer,  presents  the 
following  facts  : 

First — That  mental  emotion  may  induce  sickness  or  death 
within  a  brief  space  of  time,  or  even  immediately,  and  in  per- 
sons of  robust  health. 

Second — The  physical  phenomena  induced  by  such  cause 
indicate  a  deep  perturbation — vibration  —  of  the  nervous  system, 
and  are  generally  of  a  dynamic  character. 

Third — Thought  strongly  directed  to  any  part  tends  to 
increase  its  vascularity  and  consequently  its  sensibility. 

Fourth — Thought  strongly  directed  away  from  any  part 
diminishes  vascularity  and  lessens  sensibility.  The  more  so 
when  associated  with  powerful  emotions.  (A  key  which  un- 
locks Christian  science  and  other  "fads.") 

Fifth — The  emotions  may  cause  sensations,  either  by 
directly  exciting  the  sensitory  ganglia  and  the  central  extrem- 
ities of  the  nerves  of  sensation,  or  by  inducing  vascular  changes 
in  a  certain  part  of  the  body,  which  excite  the  sensitive  nerves 
at  their  peripheral  termination. 

Sixth — There  is  no  sensation,  whether  general  or  special, 
excited  by  agents  acting  on  the  body  from  without,  which  can 
not  be  excited  also  from  within  by  emotional  states  affecting 
the  sensory  ganglia,  such  sensation  being  referred  by  the  mind 
to  the  point  at  which  the  nerve  terminates  in  the  body.  (Tuke.) 

Christian  science  is  suggestion  plus  absurdity;  divine 
healing,  suggestion  plus  faith  in  God;  Dowieism,  suggestion 
plus  prayer  and  holy  terror;  Weltmerism,  suggestion  plus 
imagination,  pure;  magnetic  healing,  suggestion  plus  imagina- 
tion, also;  osteopathy,  suggestion  plus  massage;  homeopathy, 
suggestion  plus  nothing;  allopathy,  suggestion  plus  tubfuls  of 


30 

drugs  that  either  kill  or  cure;  regular  or  rational  medicine, 
suggestion  plus  the  best  common  horse  sense  available,  or 
suggestion  and  medicine  mixed  with  the  best  quality  of  brains 
obtainable.  No  suggestion  in  this  that  the  quality  of  brains  is 
indisputably  good  in  all  cases — or  perhaps  in  any.  Yet  that  is 
the  scientific  principle  at  the  base,  and  it  may  be  used  with 
telling  effect  in  all  cases  of  sickness,  and  is  infinitely  better 
than  the  delusions  of  the  day  by  so  much  as  it  substitutes  in- 
telligence for  ignorance  and  does  not  produce  that  disaggrega- 
tion  of  personal  consciousness  and  temporary  insanity  that  is 
the  sine  qua  non  in  Christian  science,  etc . 

THE  PARTIAL  REST  TREATMENT — In  cases  of  mild  neuras- 
thenia^ and  for  patients  who  cannot  give  up  their  entire  time  to 
the  full  rest  treatment,  which  is  often  the  case  in  men,  the  fol 
lowing  partial  rest  treatment  may  be  employed  :  On  waking 
in  the  morning,  a  cup  of  cocoa  is  taken  and  the  patient  should 
remain  in  bed  twenty  minutes  longer ;  after  this,  the  patient 
rises  and  takes  a  cool  or  cold  sponge  or  shower  bath,  after 
which  the  skin  is  vigorously  rubbed  with  a  rough  towel ;  fol- 
lowing the  bath,  breakfast  is  taken,  after  which  the  patient 
should  lie  down  for  an  hour  and  remain  at  absolute  rest,  with- 
out reading.  At  10:30  a  glass  of  milk  is  taken,  when  the 
patient  may  go  out  for  a  walk  or  drive  or  attend  to  business. 
At  1  o'clock  luncheon  or  dinner  is  taken,  after  which  meal  the 
patient  should  lie  down  for  an  hour.  In  the  afternoon  any 
recreation  may  be  taken,  or  attention  paid  to  business  until 
6:30,  when  dinner  or  supper  is  taken,  followed  by  rest  for  an 
hour.  At  9:30  the  patient  should  retire  for  the  night. 
Massage  should  be  taken  once  a  day;  before  rising  in  the 
morning,  after  the  morning  cup  of  cocoa,  or  in  the  evening  be- 
fore retiring.  A  wineglassful  of  malt  should  be  taken  with 
each  meal,  and  if  the  patient  has  impoverished  blood,  some 
simple  iron  preparation  should  be  taken.  In  conclusion,  ' '  It  is 
reiterated,"  says  Courtney,  ''that  affections  of  the  brain  and 
nervous  system  are  in  greater  measure  preventable  than  those 
of  other  parts  ;  consequently  the  mental  and  nervous  salvation 
of  the  individual  is,  practically  speaking  to  a  very  marked  ex- 
tent, within  his  own  hands,  and  may  be  worked  out  by  him 
through  rigid  attention  to  the  guidance  of  hygienic  laws." 


VI. 

THE    SPECIAL    TREATMENT    OF    NERVOUS 
BREAKDOWN. 

INSOMNIA. 

THE  THEORIES  OF  SLEEP — The  anemic  theory  supposes 
that  during  sleep  there  is  a  decreased  amount  of  blood  in  the 
brain.  The  toxic  theory  supposes  that  in  consequence  of  the 
wear  and  tear  of  the  body  tissues,  waste  products  are  generated 
which  have  a  benumbing  influence  on  the  brain  cells  which 
preside  over  the  senses.  A  Strong  proof  of  the  latter  hypothesis 
is  adduced  by  the  following  observation  of  Striimpell:  A 
young  man  had  lost  all  power  of  sensation  except  in  the  right 
eye  and  the  left  ear.  When  the  former  was  covered  by  a  bandage 
and  the  latter  stopped  by  a  plug  the  brain  of  the  subject  was 
practically  isolated  from  the  outer  world  and  the  invariable 
result  was  genuine  sleep.  "The  substance  of  the  brain,"  says 
Hammond,  in  "Sleep and  Its  Derangements,"  "is  consumed  by 
every  thought,  by  every  action  of  the  will,  by  every  sound 
that  is  heard,  by  every  object  that  is  seen,  by  every  substance 
that  is  watched,  by  every  odor  that  is  smelled,  by  every  pain- 
ful or  pleasurable  sensation,  and  soon  each  instance  of  our 
lives  witnesses  the  decay  of  some  portion  of  its  mass  and  the 
formation  of  new  material  to  take  its  place." 

During  sleep  the  physical  and  mental  functions  are  at  rest. 
Sleep  is  more  essential  to  life  than  food.  In  sleep,  muscular 
relaxation  is  absolute,  and  the  amount  of  air  inspired  by  a 
normal  man  is  one-seventh  of  that  used  during  similar  periods 
of  quiet  wakefulness.  The  pulse  is  less  rapid  and  the  brain 
contains  less  blood.  The  first  few  hours  of  sleep  are  the  most 
valuable  because  they  are  most  profound. 

AMOUNT  OF  SLEEP  NECESSARY —  In  the  time  of  Solo- 
mon, the  twenty-four  hours  were  divided  into  three  parts — 
eight  hours  for  labor  and  occupation,  eight  hours  for  rest, 


32 

refreshment  and  recreation  and  surcease  of  all  labor,  and  eight 
hours  for  sleep.  The  object  of  sleep  is  the  reconstruction  of 
overworked  organs  and  it  would  be  too  arbitrary  to  determine 
the  number  of  hours  necessary  for  sleep,  for  its  real  value  lies 
more  in  the  intensity  of  sleep  than  on  its  duration.  Again, 
the  amount  of  sleep  necessary  is  commensurate  with  the  mental 
and  physical  exercise  of  the  waking  hours.  Bight  hours  of  a 
disturbed  dreamy  sleep  is  barely  the  equivalent  of  two  hours 
of  a  deep,  dreamless  sleep.  For  this  reason,  we  can  easily 
understand  why  men  of  the  greatest  mental  activity  are  usually 
the  briefest  sleepers.  Frederick  the  Great  required  only  five 
hours'  sleep  and  Pitt  only  three  hours.  Brown  says,  that  at 
four  years,  twelve  hours'  sleep  are  needed;  at  fourteen  years, 
ten  hours;  at  seventeen,  nine  and  one-half  hours;  then  seven 
or  eight  hours  during  adult  life.  'In  old  age  continuous  sleep 
is  rare  and  the  necessity  less;  but  frequent  naps  during  the 
day  and  night,  make  up  the  average.  In  cold  countries  more 
sleep  is  required  than  in  warm  climates. 

CONDITIONS  FAVORING  SLEEP— A  well  ventilated  room, 
cool,  dark  and  quiet.  A  comfortable  bed  with  a  moderate 
amount  of  covering.  Mental  worries  and  intense  thoughts  in- 
terfere with  sleep.  Sleep  is  a  powerful  habit.  A  person  who 
awakens  at  a  certain  hour  for  several  successive  nights,  even- 
tually establishes  the  habit  of  awakening  at  that  hour.  The 
habit  should  be  cultivated  of  retiring  and  awakening  at  a 
definite  hour. 

THE  CAUSES  OP  INSOMNIA  OR  SLEEPLESSNESS — Prof. 
See  divides  all  causes  of  insomnia  into:  1 — Psychical,  and  2. — 
Physical.  The  causes  of  psychical  insomnia  include  cases  of 
sleeplessness  dependent  on  mental  emotion,  to  thought,  worry, 
that  is,  to  causes  not  directly  dependent  on  organic  disease. 
Young,  the  well  known  author  of  ''Night  Thoughts,"  was 
presumably  thus  afflicted — 

' '  From  short  as  usual  and  disturbed  repose, 

I  awake.     How  happy  those  that  wake  uo  more; 

I  awake  emerging  from  a  sea  of  dreams 

Tumultuous,  where  my  wrecked  despondent  thought 

From  wave  to  wave  of  fancied  miser}' 

At  random  drove,  her  helm  of  reason  lost!" 


33 

The  worries  of  the  student,  the  merchant,  the  speculator, 
homesickness  and  disappointments  are  of  this  order.      In  the 
treatment  of  such  cases,  the  physician  is  often  powerless  to  act. 
"  Who  shall  minister  to  a  mind  diseased; 
Pluck  from  the  memory  a  rooted  sorrow, 
'Rase  out  the  written  troubles  of  the  brain, 
And  with  some  sweet  oblivious  antidote 
Cleanse  the  stuffed  bosom  of  that  perilious  stuff 
Which  weighs  upon  the  heart?" 

PHYSICAL,  CAUSES — Every  deviation  of  health  is  charac- 
terized by  disturbance  of  sleep,  but  in  most  cases  where  a 
vicious  sleep  habit  is  established,  it  tends  to  persist.  Among 
the  chief  causes  are:  1 — Brain  strain.  2 — Organic  disease 
of  the  brain  and  arteries.  3 — Stomach  and  intestinal  diseases. 
4. — Irritation  of  the  sexual  organs.  5 — Poisonous  substances 
(toxic  insomnia). 

THE  INSOMNIA  OF  BRAIN  STRAIN — An  increase  in  the 
supply  of  blood  to  the  brain  eventuating  in  cerebral  congestion. 
It  is  an  undoubted  fact,  that  the  brain  strain  of  severe  mental 
labor  is  measurably  lessened  by  an  adequate  amount  of  physical 
exercises.  Physiologists  and  hygienists  have  shown  this  to  be 
true,  yet  we  must  be  cautious  in  going  to  the  other  extreme, 
taking  too  much  physical  exercise;  for  otherwise,  the  poison- 
ous substances  generated  by  muscular  fatigue  only  tend  to 
excite  the  brain  and  tend  to  insomnia. 

THE  INSOMNIA  OF  ORGANIC  DISEASE  OF  THE  BRAIN 
AND  ARTERIES — Whenever  the  nutrition  of  the  brain  is 
compromised  by  actual  disease,  then  insomnia  of  an  aggravat- 
ing and  persistent  character  results.  When  the  insomnia  is 
caused  by  brain  congestion,  there  is  flushing  of  the  face,  red- 
ness of  the  eyes,  giddiness,  confusion  of  ideas,  and  sometimes 
stupor. 

THE  INSOMNIA  OF  STOMACH  AND  INTESTINAL  DIS- 
EASE— In  indigestion,  toxic  substances  are  developed  which 
irritate  the  brain  and  prevent  sleep.  In  many  instances,  the 
accumulation  of  gases  in  the  stomach  and  intestines  by  press- 
ing on  important  organs,  notably  the  heart  and  lungs,  induce 
sleeplessness  indirectly.  Some  persons  sleep  best,  if,  before 


34 

retiring  they  take  a  light  repast;  others,  on  the  contrary,  would 
find  such  a  procedure  an  indiscretion,  certain  to  be  followed  by 
insomnia.  Sleep  after  eating  is  a  salutary  procedure.  It  draws 
the  blood  from  the  brain  to  the  stbrttach  and  thus  facilitates 
digestion. 

Toxic  INSOMNIA — Insomnia  induced  by  the  indiscrimi- 
nate use  of  poisonous  substances  like  alcohol,  coffee,  tea,  to- 
bacco, etc.  Not  infrequently  the  inhibition  of  any  one  of  these 
substances  will  often  cure  an  intractable  insomnia. 

TREATMENT  OF  INSOMNIA — It  has  been  truly  said  that  if 
sleep  and  hope  should  be  taken  from  man  he  would  be  the  most 
miserable  being  in  existence.  Much  can  be  attained  by  obey- 
ing the  laws  of  hygiene.  Attention  must  be  directed  to  a 
minute  investigation  of  all  the  bodily  functions  to  ascertain  the 
fundamental  condition,  of  which  insomnia  is  a  mere  manifesta- 
tion. We  possess  many  drugs  which,  when  prescribed  by  the 
physician  with  discretion,  may  be  regarded  as  harmless,  yet 
drugs  should  only  be  used  as  a  last  resort,  for  any  drug  which 
induces  sleeep  by  overpowering  the  body  is  not  entirely  with- 
out danger.  Generally  speaking,  an  adequate  amount  of  phys- 
ical exercise  is  necessary  in  all  sufferers  from  insomnia.  Noth- 
ing is  more  conducive  to  sleep  than  exercise  taken  in  the  open 
air.  Some  diversion  for  the  brain  worker  may  be  found  in 
change  of  scene  and  society.  * '  Seeing  that  too  much  sadness 
has  congealed  your  blood  and  melancholy  is  the  nurse  of 
frenzy,  therefore  have  thought  it  good  for  you  to  hear  a 
play,  and  frame  your  mind  to  mirth  and  merriment  which  bars 
a  thousand  harms  and  lengthens  life." 

No  detail  should  be  neglected  in  ascertaining  the  cause  of 
insomnia.  Tea  or  coffee  should  not  be  taken  at  the  evening 
meal  and  tobacco  should  not  be  used,  at  least  some  hours  be- 
fore retiring.  A  glass  of  warm  milk,  or  a  cup  of  hot  bouillon 
before  retiring  may  prove  beneficial  in  inducing  sleep.  Some 
derive  sleep  by  taking  a  glass  of  beer  or  malt  extract  before  re- 
tiring. If  the  sufferer  from  insomnia  be  a  literary  man  or 
student,  all  intellectual  effort  should  be  stopped  at  least  an  hour 
before  retiring,  and  the  interval  filled  in  with  some  extraneous 
dull  reading.  When  this  fails,  no  intellectual  work  should  be 


35 

done  after  supper,  reserving  that  work  for  the  early  morning 
hours.  Some  cases  of  insomnia  only  yield  after  a  complete 
change  of  scene  free  from  excitement  and  sight  seeing.  Active 
exercise  before  retiring,  with  dumb-bells,  pulley-weights  or 
Indian  clubs,  followed  by  a  tepid  or  warm  sponge  bath,  often 
induces  healthful  and  refreshing  sleep.  Climate  is  an  essential 
consideration  in  those  who  suffer  from  insomnia.  Warm  cli- 
mates are  soothing  and  cool  climates  stimulating  to  the  ner- 
vous system.  On  account  of  the  cool  nights  in  mountainous 
districts,  refreshing  sleep  can  often  be  obtained.  Some  find 
benefit  by  residing  at  the  seashore. 

Hydr other apy  is  a  valuable  adjunct  in  the  treatment  of 
insomnia.  Schneller's  experiments  proved  conclusively  that  ice 
applied  to  the  head  of  an  animal  caused  contraction  of  the 
blood  vessels  of  the  brain  which  persisted  for  a  short  time  after 
the  ice  was  removed.  The  brief  application  of  cold  or  warm 
water  to  the  surface  of  the  body  is  stimulating,  but  if  prolonged, 
depressent.  A  cool  sponge  bath,  or  even  a  cold  plunge  before 
retiring,  will  provoke  sleep.  The  secondary  effect  of  cold  to 
the  skin,  is  to  dilate  the  blood  vessels  which  draw  the  blood 
away  from  the  brain.  Many  sufferers  find  relief  in  a  prolonged 
warm  bath  before  retiring,  the  effect  being  sedative  on  the 
nervous  system.  Others  find  equal  benefit  in  a  hot  foot  bath. 
Some  find  relief  in  a  Turkish  bath  followed  by  general  massage. 
The  wet  pack  has  done  heroic  service  for  many  nervous  per- 
sons. It  is  used  as  follows  :  A  sheet  having  been  wrung  out 
of  cold  water,  is  thrown  over  the  patient  from  neck  to  ankles, 
and  over  this  several  dry  blankets,  with  a  hot  water  bag  to  the 
feet  and  a  cold  wet  cloth  to  the  forehead.  The  patient  remains 
in  the  pack  from  half  an  hour  to  an  hour,  and  is  then  vigor- 
ously rubbed  with  a  coarse  dry  cloth  until  the  skin  glows.  The 
wet  pack  may  be  given  every  night  or  several  times  a  week. 

Hot  compresses,  consisting  of  flannels  wrung  out  of  hot 
water,  applied  to  the  abdomen  and  covered  with  dry  flannels,  are 
often  efficacious.  A  hot  bag  may  be  substituted.  The  cold 
douche  to  the  head,  or  a  shower  bath  to  the  head  and  spine,  are 
frequently  serviceable. 


Massage  is  often  of  service  in  insomnia  when  every  other 
hygienic  measure  fails. 

Some  persons  can  induce  sleep  by  having  recourse  to  the 
hop  pillow,  which  should  be  moistened  with  spirits  before  being 
placed  under  the  head  of  the  patient.  Among  drugs,  bromide 
of  potash  is  the  least  harmful.  For  an  adult,  30  grains  may  be 
taken  in  sweetened  water  before  retiring  and  repeated  in  an 
hour  if  necessary.  It  is  especially  useful  in  nervous  cases. 

Electricity,  when  properly  employed,  especially  in  the  form 
of  static  electricity,  is  almost  an  indispensable  remedy  in 
insomnia.  Contrary  results  often  follow  its  injudicious  applica- 
tion. The  galvanic  current  has  a  tendency  to  make  some 
persons  sleepy  and  is  to  be  applied  in  the  evening,  The 
Faradic  current  makes  most  people  wakeful.  Electricity  is 
especially  useful  in  the  insomnia  of  brain  strain  and  alcoholism. 

Hypnotism  is  likewise  an  indispensable  agent  when  judici- 
ously emploved. 

A  common  procedure  for  inducing  sleep  is  energetic  and 
frequently  repeated  opening  and  closing  of  the  eyelids. 
Auto-suggestion  is  often  of  service.  The  patient  should 
go  to  bed  with  the  firm  conviction  that  sleep  is  bound 
to  follow.  One  may  imagine  observing  all  the  phenomena 
incident  to  sleep  in  another  person.  The  reading  of  dull  books 
or  concentrating  the  mind  on  some  blank  and  wearying  picture 
makes  the  mind  receptive  to  only  one  suggestion,  viz:  sleep  are 
some  means  often  employed. 

"  A  flock  of  sheep  that  leisurely  pass  by 
One  by  one  ;  the  sound  of  rain  and  bees 
Murmuring  ;  the  fall  of  rivers,  winds  and  seas, 
Smooth  fields,  wide  sheets  of  water  and  pure  sky." 


TREATMENT  OF  THE  HEART  SYMPTOMS. 

THE  TREATMENT  FOR  PALPITATION  OF  THE  HEART — 
Absolute  rest  in  bed  in  a  large  ventilated  and  darkened  chamber 
with  the  clothing  removed.  The  application  of  an  ice-bag  to  the 
region  of  the  heart  or  cloths  saturated  in  cold  water  are  very 
effective  agents.  Swallowing  small  pieces  of  ice  or  drinking 


37 

large  draughts  of  cold  water  or  a  glass  of  hot  water  are  pro- 
cedures frequently  adopted.  To  prevent  attacks  of  palpitation, 
excitement  of  all  kind  must  be  avoided  and  tea,  coffee, 
and  alcohol  must  be  discontinued  or  at  least  reduced.  When 
the  palpitation  is  dependent  on  impoverished  blood,  iron  in  some 
form  is  serviceable.  When  a  stomach  disturbance  is  at  the 
bottom  of  the  trouble  it  must  be  cured.  Electricity  is  an  effective 
agent.  When  everything  else  fails,  the  rest  cure  gives  remark- 
ably good  results. 

TREATMENT  OF  NERVOUS  DYSPEPSIA — In  the  majority 
of  instances,  indigestion  is  caused  by  too  rapid  eating  and  the 
consumption  of  too  much  food.  Digestion  begins  in  the  mouth. 
This  is  especially  true  of  the  digestion  of  starchy  foods.  Many 
dyspeptics  are  cured  of  their  evil  by  thoroughly  masticating 
their  food.  A  meal  should  be  regarded  as  a  pastime,  not  a 
necessity.  It  is  difficult  and  even  impossible  to  lay  down  any 
definite  rule  for  the  kind  of  food  to  be  consumed,  for  "  one  man's 
food  is  another  man's  poison."  The  nervous  dyspeptic  is  as  a 
rule,  poorly  nourished.  It  is  absurd  to  suppose  that  nervous 
prostration  can  be  cured  without  increasing  and  making  the 
nourishment  effective.  An  exhausted  nervous  system  demands 
a  plentiful  supply  of  good  nutritious  food.  Beard  maintains 
in  his  classic  work  on  '  *  Sexual  Neurasthenia' '  that  flesh  is  the 
natural  food  of  man.  His  theory  of  diet  is  founded  on  the 
theory  of  evolution  and  finds  expression  in  the  following  three 
propositions :  1 — Living  beings  feed  on  that  which  is  below  them 
in  the  scale  of  development.  2— The  best  food  for  man  is  that 
which  is  just  below  him  or  nearest  to  him  in  the  scale  of 
development.  3 — Food  is  difficult  of  assimilation  for  man  in 
proportion  to  its  distance  below  him  in  the  scale  of  develop- 
ment. It  is  undoubtedly  true,  that  those  who  subsist  exclus- 
ively upon  meat  are  capable  of  greater  mental  and  physical 
exertion  than  those  who  consume  vegetable  food.  Animal 
food  contains  the  greatest  variety  of  nutriment  and  is  generally 
most  easily  digested.  Beef  is  more  nutritious  and  stimulating 
than  mutton.  The  flesh  of  very  young  animals  is  less  nutri- 
tious and  more  difficult  of  digestion  than  the  flesh  of  the 
matured  animal.  Oysters  are  very  nutritious  and  digestible 


38 

when  consumed  raw.  Oatmeal  is  a  frequent  cause  of  indiges- 
tion in  the  nervous  dyspeptic.  Eggs,  milk  and  fish  are  very 
nutritious.  When  the  dyspepsia  is  severe,  an  exclusive  milk 
diet  for  several  weeks  proves  curative.  The  daily  amount 
necessary  must  never  be  less  than  three  pints  and  as  much  as  a 
gallon.  A  large  glassful  should  be  drunk  slowly  every  hour, 
and,  when  toleration  is  established  this  amount  may  be  increas- 
ed at  shorter  intervals.  The  digestibility  of  the  milk  may  be 
increased  by  adding  a  pinch  of  salt  or  a  teaspoonfui  of  lime 
water  to  each  glass.  Some  prefer  taking  the  milk  diluted  with 
water  or  seltzer.  When  whole  milk  is  loathsome,  it  may  be 
skimmed  or  substituted  by  buttermilk.  Farinaceous  foods 
should,  as  a  rule,  be  excluded  as  they  create  flatulency  and 
heartburn.  Too  much  liquid  should  not  be  taken  at  a  meal 
as  it  dilutes  the  gastric  juice  and  inhibits  digestion.  Hygienic 
measures,  such  as  exercise  and  bathing,  are  indispensable,  for, 
by  increasing  the  tone  of  the  nervous  system  they  indirectly 
improve  digestion.  Sufferers  from  nervous  dyspepsia  will  find 
material  aid  by  carrying  out  the  partial  rest  treatment  and 
confining  themselves  to  the  following  diet  which  excludes 
starchy  foods  which  are  notoriously  indigestible  in  neurasthenic 
persons. 

On  waking,  eight  ounces  of  equal  parts  of  hot  milk  and 
seltzer  water,  taken  slowly.  Breakfast,  steak  or  loin  chops  with 
fat,  soft  boiled  or  poached  egg,  cream  toast  (very  little),  half  a 
pint  of  milk  and  a  small  cup  of  coffee.  Lunch,  10  A.  M.,  small 
teacup  of  squeezed  beef  juice  with  stale  bread.  12  M,  rest 
or  sleep.  Midday  meal,  12:30  P.  M.,  fish,  chicken,  scraped 
meat  ball,  stale  bread  with  plenty  of  butter,  baked  apples  and 
cream,  two  glasses  of  milk.  Lunch,  4  p.  M.,  bottle  of  koumyss, 
raw  scraped  beef  sandwich  or  goblet  of  milk.  5:30  P.  M., 
rest  or  sleep.  Dinner,  6  P.  M.,  meat  or  fresh  soup,  roast  or 
mutton,  game,  stale  bread  (sparingly),  fresh  vegetables, 
(excepting  potatoes).  Eat  slowly,  chew  the  food  thoroughly, 
and  never  eat  when  excited  or  exhausted.  Poorly  prepared 
meals  are  often  a  source  of  dyspepsia.  Washing  the  stomach 
by  means  of  a  tube  is  often  indicated  for  the  relief  of  dyspepsia. 
Constipation  is  frequently  a  cause  of  dyspepsia  and  loss  of 
appetite. 


"A*K\ 
9*rxm  \ 

ERSITY 


f  XTNIVERSITY 


Personally  I  have  observed  only  temporary  good  to  result 
from  the  use  of  such  agents  as  pepsin,  pancreatin  and  hydro- 
chloric acid.  To  stimulate  digestion  strychnin  is  often  invalu- 
able. The  addition  of  common  salt  to  our  food  stimulates 
digestion.  Alcohol  should  be  stopped,  although  there  can  be 
no  objection  to  a  moderate  use  of  some  light  wine  taken  with 
meals. 

RULES  FOR  DYSPEPTICS. 

RULE  I.  —  Eat  slowly  and  chew  the  food  thoroughly.  If 
the  foregoing  are  not  observed  then  follow  the  rule  of  Sir 
Andrew  Clark,  viz:  Count  the  bites.  For  every  mouthful  of 
meat  thirty-two  bites  must  be  allowed,  or  one  bite  to  every 
tooth.  If  the  meat  is  tough  sixty-four  bites  must  be  allowed, 
and  ninety  -six  bites  if  very  tough.  This  rule  is  an  almost 
positive  protection  against  dyspepsia  and  will,  in  most  instances, 
cure  the  disease. 

RULE  II.  —  Solids  and  liquids  must  be  taken  at  separate 
times.  l,iquid  taken  with  food  in  those  with  weak  stomachs 
dilutes  the  gastric  juice  and  retards  digestion.  Then  again, 
when  liquids  are  not  taken  with  the  food  it  induces  the  patient 
to  chew  the  food  thoroughly  or  otherwise  it  cannot  be  swal- 
lowed. If  at  breakfast  tea  or  coffee  must  be  drunk  it  is  better 
taken  at  the  completion  of  the  meal. 

RULE  III.  —  Farinaceous  and  proteid  foods  should  not  be 
taken  at  the  same  meal,  in  other  words,  the  same  character  of 
food  only  should  be  introduced  into  the  stomach  at  the  same 
meal.  For  example:  Bread  and  butter  may  be  taken  at 
breakfast,  but  no  meat,  fish  or  eggs.  L,uncheon  should  consist 
of  fish,  eggs  or  meat,  but  no  bread,  potatoes  or  other  farina- 
ceous food.  Supper  should  consist  of  the  same  kind  of  food  as 
at  luncheon  or  farinaceous  food  only.  Introducing  the  same 
kind  of  food  into  the  stomach  at  each  meal  insures  the  com- 
pletion of  digestion  at  the  same  time,  and  not  at  different 
times,  as  would  be  the  case  if  the  character  of  the  food  taken 
at  a  meal  is  different. 


40 

RULE  IV. — If  liquid  must  be  taken  at  a  meal,  the  best 
drink  is  hot  water,  taken  on  rising  in  the  morning,  at  12 
o'clock  and  again  at  4  p.  M.  Taken  at  these  intervals  there 
will  be  do  dilution  of  the  gastric  juice  and  the  contents  of  the 
previous  meal  will  be  washed  out  of  the  stomach. 

TREATMENT  OF  CONSTIPATION. — Each  case  of  constipa- 
tion must  be  investigated  as  an  individual  one.  Habit  is  an 
important  factor.  The  desire  to  go  to  stool  must  never  be 
neglected,  in  fact  it  is  to  be  encouraged  by  a  systematic  habit 
of  going  to  the  toilet  every  morning  whether  or  not  the  desire 
is  present.  Such  a  practice  will  often  cure  the  costive  habit. 
Many  persons  find  that  a  cigar  or  pipe  after  breakfast  acts  as  a 
laxative.  Massage  of  the  abdomen  is  constantly  practiced, 
but  I  confess  never  to  have  seen  any  good  results  from  its  use, 
save  in  children  and  very  young  persons.  Many  persons 
succeed  in  obtaining  a  daily  evacuation  by  taking  certain 
articles  of  food.  Fruit,  raw  or  cooked,  taken  at  breakfast,  is 
often  effectual.  Some  find  oatmeal  or  brown  bread  to  have  a 
similar  effect.  Water  should  be  drunk  in  abundance,  espe- 
cially before  retiring  or  on  rising  in  the  morning.  Others  find 
that  a  glass  of  raw  milk  taken  before  breakfast  will  act  as  a 
laxative.  Exercise  is  of  great  value,  especially  exercise 
like  horseback  riding,  which  brings  the  abdominal  muscles  into 
play.  The  continued  use  of  purgatives  is  a  dangerous  prac- 
tice. They  are  only  temporary  in  action  and  make  the  bowels 
more  constipated  than  ever.  The  least  objectionable  agents 
of  this  class  are  the  natural  purgative  waters  like  Carlsbad 
and  Hunyadi  Janos.  In  California  we  possess  an  effective 
natural  water  called  Bythinia.  Suppositories  of  glycerin  or 
a  daily  enema  of  cold  water  is  of  great  value.  The  same  may 
be  said  of  olive  oil.  Glycerin  (a  tablespoonful  to  four  table- 
spoonfuls),  thrown  into  the  rectum  is  very  effective.  Cold 
sponging  and  baths  are  valuable  additions  to  the  measures 
suggested. 


VII. 
SPECIAL   FORMS  OF    NEURASTHENIA. 


CONGESTIVE   NEURASTHENIA. 

Whittle,  of  London,  in  1889,  wrote  an  interesting  broch- 
ure on  this  special  form  of  neurasthenia,  but  it  seems  to  have 
escaped  the  serious  consideration  of  the  medical  profession.  I 
have  repeatedly  been  able  to  confirm  the  observations  of 
Whittle.  He  describes  a  form  of  nerve  depression  resulting 
from  brain  congestion  and  illustrates  the  remarkable  efficacy  of 
blood-letting,  either  by  leeches  or  venesection  in  its  treatment. 
The  particular  patients  who  are  thus  benefitted,  look  to  the 
uninitiated  eye,  the  picture  of  health,  but  are  really  miserable 
victims  to  whom  actual  pain  or  some  evident  disease  would 
prove  an  agreeable  distraction.  Their  faces  are  flushed,  eyes 
watery  and  there  is  a  lightness  in  the  head  with  occasional 
aching  of  a  dull,  heavy  character  about  the  forehead.  The 
majority  of  cases  occur  between  the  ages  of  30  and  40,  very 
few  under  25  or  over  50.  This  includes  the  most  active  and 
wearing  period  of  life.  If  a  man  can  stand  the  strain  of  this 
period,  he  will  be  proof  against  anything  he  may  encounter 
afterward.  Congestive  neurasthenia  occurs  more  frequently 
in  males  than  females  and  the  most  constant  factor  in  its  pro- 
duction is  continuous  brain  strain. 

During  sleep,  such  as  it  is,  the  body  rests  but  not  the 
brain.  As  a  result  the  brain  becomes  unduly  charged  with 
blood,  leading  to  congestion,  which  nothing  seems  to  relieve  so 
quickly  and  marvelously,  as  blood-letting.  Leeching  is  one  of 
the  good  remedies  out  of  fashion,  and  while  formerly  it  was 
the  custom  to  bleed  too  much,  it  is  unfortunate  that  now  we  do 
not  bleed  enough.  I  remember  one  congestive  neurasthenic 
who,  by  actual  calculation,  had  consulted  twenty-three  differ- 
ent physicians,  among  whom  were  some  of  the  leading  nerve 


42 

specialists  of  Europe.  In  addition  he  had  made  a  number  of 
sea  voyages  and  visited  many  celebrated  spas  but  with  abso- 
lutely no  relief.  Incidentally  an  eye  trouble  necessitated  the 
application  of  leeches  by  his  oculist  to  the  temples  resulting  in 
immediate  relief  to  his  nerve  symptoms  which  had  hitherto 
baffled  all  treatment.  Six  months  later  his  old  symptoms 
returned  but  the  reapplication  of  leeches  and  the  withdrawal 
of  blood  from  the  brain  vessels  was  as  successful  as  in  the 
primary  instance, 

URIC  ACID   NEURASTHENIA. 

Brain  workers  often  suffer  from  a  series  of  per- 
plexing symptoms  which  baffle  the  skill  of  their  medical 
advisers.  Such  sufferers  are  usually  good  livers  and 
lead  sedentary  lives.  With  such,  insomnia,  headache, 
mental  depression,  backache  and  dyspepsia  are  prominent 
signs.  Such  individuals  are  really  sufferers  from  uric  acid 
poisoning.  It  was  Alexander  Haig,  of  London,  who,  in  his 
memorable  work  on  '  *  Uric  Acid  as  a  Factor  in  the  Causation 
of  Disease,"  made  many  perplexing  problems  clear  which  had 
heretofore  remained  unrecognized.  Uric  acid  occurs  in  the 
blood  in  traces  during  health.  It  is  derived  chiefly  from  foods, 
and  persons  who  eat  an  excess  of  food  and  take  little  exercise 
produce  an  excessive  quantity  of  uric  acid,  which  accumu- 
lating in  the  blood,  gives  rise  to  a  train  of  symptoms.  The 
blood  is  naturally  alkaline  and  holds  the  uric  acid  in  solution, 
but  if  from  any  cause  the  blood  becomes  acid,  it  can  no  longer 
hold  the  uric  acid  in  solution,  and  consequently  the  latter  is 
precipitated.  Now  the  joints,  muscles  and  ligaments  are  fav- 
orable sites  for  the  precipitation  of  uric  acid,  hence  those  who 
suffer  from  uric  acid  poisoning  complain  of  muscular  pains  in 
the  back  and  joint  stiffness.  The  heart  is  also  frequently 
affected.  Every  time  a  muscle  contracts,  and  the  heart  is 
essentially  a  muscular  pump,  it  produces  an  acid.  Now  an 
acid  favors  the  precipitation  of  uric  acid,  hence  the  heart 
attracts  uric  acid,  which,  accumulating  in  its  substance,  event- 
ually leads  to  inflammation  and  weakness  of  that  organ. 


43 

Headache  is  a  frequent  symptom  and  so  is  neuralgia. 
The  urine  is  highly  acid,  highly  colored,  and  deposits  a  brick 
dust  sediment  on  standing.  Chronic  diseases  of  the  liver  and 
kidneys  owe  their  origin  to  the  excessive  formation  and 
defective  elimination  of  uric  acid. 

TREATMENT  OF  URIC  ACID  NEURASTHENIA — Insomuch 
as  overeating  and  overdrinking,  combined  with  insufficient 
muscular  exercise,  are  the  essential  causes  of  uric  acid  poison- 
ing, persons  predisposed  to  this  intoxication  should  live  tem- 
perately, abstain  from  alcohol  and  eat  moderately.  Any 
hereditary  tendency  can  be  overcome  by  an  open  air  life  with 
an  abundance  of  exercise  and  regular  hours.  Meat  must  be 
eaten  sparingly,  especially  red  meat.  Authorities  differ  in 
their  recommendation  of  food,  some  advising  an  exclusively 
vegetable,  others  an  animal  diet.  A  good  rule  is  to  diminish 
the  amount  of  food,  especially  meat,  consuming  the  latter  but 
once  a  day  and  to  get  up  from  the  table  always  feeling  a  little 
hungry.  ' '  Moderation  in  all  things, ' '  says  Balfour,  * ( is  a  certain 
passport  to  longevity.  It  enables  us  to  live  healthy  for  as  long 
as  we  may."  Water,  especially  mineral  water,  should  be  drunk 
freely,  as  it  cleanses  the  blood  and  favors  the  elimination  of 
uric  acid.  The  skin  should  be  kept  active  by  some  form  of 
exercise  sufficient  to  produce  free  perspiration.  An  occasional 
Turkish  bath  should  be  taken.  Care  should  be  taken  to  avoid 
chilling  of  the  skin  by  dressing  warmly.  A  large  number  of 
remedies  have  been  suggested  to  promote  the  excretion  of  uric 
acid, — such  remedies  as  the  lithium  salts,  colchicum,  iodide  of 
potash,  piperazin  and  the  salicylates,  but  they  ought  not  to  be 
taken  without  the  advice  of  a  physician.  For  general  use  I 
can  warmly  recommend  a  preparation  known  as  the  Vita 
Aurantii  litholytica  (Haber).  Each  tablespoonful  of  the  solu- 
tion, containing  phosphate  of  soda,  30  grains ;  citrate  of  lithia,  5 
grains,  and  salicylate  of  soda,  2j£  grains.  Of  this  solution,  a 
tablespoonful  is  taken  in  water  after  each  meal.  It  has  a  laxa- 
tive effect,  and  when  this  becomes  too  pronounced,  the  dose 
may  be  reduced. 


44 


SEXUAL   NEURASTHENIA. 

When  the  symptoms  of  neurasthenia  predominate  in 
the  sexual  apparatus,  we  speak  of  sexual  neurasthenia. 
In  neurasthenia  the  sexual  power  is  usually  very  much 
diminished,  either  by  incomplete  erections,  premature  ejac- 
ulations or  night  emissions.  Married  men  find  this  weak- 
ness a  source  of  much  mental  suffering,  and  the  constant 
fear  of  impotency  prompts  them  to  seek  medical  advice.  It  is, 
without  doubt,  true  that  the  majority  of  functional  troubles  of 
the  sexual  organs  are  of  a  neurasthenic  nature.  Whatever  the 
changes  may  be  in  his  sexual  apparatus,  the  unfortunate  suf- 
ferer is  inclined  to  exaggerate  them  by  a  vivid  imagination  or 
by  the  perusal  of  o^uack  advertisements.  Normal  ingredients 
of  the  urine,  such  as  phosphates  and  urates,  passed  by  such 
persons,  is  declared  by  charlatans,  to  be  seminal  fluid.  Al- 
though seminal  fluid  may  be  passed  during  urination  or  defeca- 
tion, it  is  nevertheless  a  rare  occurrence. 

Involuntary  seminal  emissions  in  a  healthy  unmarried  man, 
occurring  at  different  periods,  must  always  be  regarded  as  an 
evidence  of  good  health.  It  is  only  when  the  emissions  are 
followed  by  depression,  vague  pains  in  the  head  and  a  feeling 
of  exhaustion,  that  they  are  to  be  regarded  as  harmful.  Some 
individuals  suffer  no  inconvenience  from  night  emissions,  oc- 
curring even  as  often  as  several  times  a  week,  whereas  in 
others,  a  simple  emission  once  a  week,  or  even  less  often,  is 
attended  by  the  signs  previously  noted.  Seminal  emissions  may 
be  the  cause  of  nerve  depression,  not  the  consequence  of  the  loss 
of  semen,  but  from  the  nerve  exhaustion  following.  More  often, 
the  emissions  are  the  result  of  nerve  depression.  It  frequently 
happens  that  sufferers  from  seminal  emissions  attribute  their 
trouble  to  the  habit  of  self  abuse.  While  the  habit  is  unfor- 
tunately well  nigh  universal  among  both  sexes  and  animals, 
and  frequently  attended  by  dire  results,  the  latter  have,  no 
doubt,  been  greatly  exaggerated. 

Spermatorrhea  or  the  passing  of  semen  with  the  urine  or 
during  defecation  is  indicative  of  grave  debility  of  the  sexual 
apparatus.  It  is  usually  the  result  of  neglected  or  improperly 


45 

treated  seminal  emissions.  Many  cases  of  so  called  sperma- 
torrhea  it  must  be  emphasized  are  really  urethral  discharges, 
other  than  semen.  The  microscope  alone  can  determine  the 
nature  of  the  discharge. 

Impotence  signifies  one  of  the  following  conditions: 
1.  —  Deficiency  of  desire  and  power.  2. —  Deficiency  of 
power  with  increased  desire.  3. — Abnormal  erectile  power 
known  as  priapism  in  which  there  is  no  discharge  of  semen. 
Very  often  the  impotence  is  imaginary,  a  form  known  as 
psychical  impotency.  It  is  strange  that  people  are  not  better 
educated  in  regard  to  their  sexual  functions.  All  they  learn 
is  of  a  suggestive  nature  by  the  reading  of  erotic  literature 
and  quack  advertisements.  Among  the  prominent  symptoms 
of  sexual  neurasthenia,  are:  dimness  of  vision,  back  pains, 
mental  depression  and  defective  memory,  dyspepsia,  palpitation 
of  the  heart  and  dizziness.  In  women,  sexual  neurasthenia 
presents  symptoms  similar  to  that  of  man,  although  they  occur 
with  less  frequency.  Some  suffer  from  nocturnal  orgasms 
accompanied  by  dreams  and  they  awake  feeling  nervous,  de- 
pressed and  exhausted.  In  married  women,  the  sexual  appe- 
tite may  be  increased  at  first,  but  it  rapidly  disappears  to  be 
followed  very  often  by  distaste  or  even  disgust. 

The  sexual  hypochondriac.  —  This  unfortunate  creature, 
boy,  girl,  man  or  woman,  usually  lives  a  life  of  profound 
despondency,  the  result  of  a  real  or  fancied  disturbance  of  the 
sexual  organs.  Such  cases  demand  a  true  explanation  of  the 
disorder,  but  when  the  morbid  state  of  mind  is  encouraged 
by  the  ^harJLatan  only  direful  results  follow.  There  is  no 
sufferer  tcT^wtrcfln  truth  is  more  repellent  than  the  sexual 
hypochrondriac,  in  fact  his  morbid  fear  is  a  delusion  which  he 
wishes  to  have  verified.  The  sexual  hypochondriac  may  be 
the  victim  of  one  of  the  following  disorders:  Involuntary 
seminal  discharges,  impotency,  masturbation,  orsyphilophobia. 

Involuntary  seminal  discharges  are  quite  natural  and 
occur  in  all  persons  who  lead  a  correct  and  continent  life  and 
are  not  unlike  menstruation  occuring  in  women  at  periodic 
intervals.  The  "night  emissions"  are  not  necessarily  the  in- 
voluntary discharge  of  semen  but  are  often  made  up  of  a  fluid 


46 

derived  from  the  prqstate  gland.  Some  persons  secrete  a 
larger  quantity  of  prostatic  fluid  than  others,  hence  it  is  quite 
within  the  limits  of  health  for  such  individuals  to  have  involun- 
tary discharges  at  more  frequent  intervals.*  Then  again,  the 
character  of  food  eaten  has  a  notable  influence  on  the  amount 
of  seminal  or  prostatic  fluid  secreted.  The  milky  character 
of  the  urine  in  the  sexual  hypochrondriac  is  not  semen  but 
phosphates^  a  fact  which  is  made  evident  when  a  little  acid  is 
added  to  the  urine,  resulting  in  the  complete  disappearance 
of  the  milky  character  of  the  urine.  The  mucilage-like  fluid 
observed  at  the  head  of  the  penis  after  stool  is  often  of  no  con- 
sequence, consisting  as  it  often  does  of  the  secretion  of  the 
prostate  gland. 

Impotency,  or  fondly  called  * '  lost  manhood ' '  by  the  adver- 
tising quack,  is  in  most  instances  an  imaginary  condition. 
True  manhood  finds  no  index  in  the  vigor  of  the  sexual  appa- 
ratus. The  more  man  approaches  the  condition  of  brute 
creation,  the  more  powerful  is  his  sexual  instinct. 

As  man  and  woman  ascend  the  scale  of  moral  and  social 
life,  there  is  less  inclination  for  the  performance  of  the  sexual 
act.  Such  individuals  are  both  potent  and  impotent  at  times. 
The  best  type  of  a  married  man  is  only  potent  in  the  presence 
of  his  consort.  If  he  demonstrates  this  potency  toward  another 
his  moral  standard  is  as  low  as  the  negro  who  commits  rape  as 
often  as  occasion  permits.  An  indefinite  number  of  unfore- 
seen conditions  like  mental  and  physical  fatigue,  disgust,  worry 
and  anger,  conduce  to  make  every  man  impotent  at  times. 
The  fear  and  timidity  which  possess  the  newly  married  are 
evidences  of  morality  and  not  sexual  weakness.  It  has  been 
estimated  by  a  trustworthy  statistician  that  at  least  60  per  cent 
of  young  husbands  fail  in  the  first  sexual  attempts  after  mar- 
riage. There  are  many  individuals  who  are  impotent,  owing 
to  their  overwhelming  fear  of  contracting  some  disease.  There 
are  persons  who  manifest  impotency  toward  certain  women,  but 
who  are  fully  capable  of  performing  the  act  with  others. 

Unnatural  practices  are  bound  to  be  followed  by  impo- 
tency. The  sexual  act  when  aroused  by  artificial  means  finds 
no  response  when  invoked  by  natural  methods.  Sexual 


47 

psychopathy,  or  the  attainment  of  sexual  desire  by  unnatural 
means,  is  a  stigma  of  degeneration  manifested  in  persons  who 
have  inherited  or  acquired  a  defective  nerve  organization,  and 
is  common  among  the  insane. 

Masturbation  may  conduce  to  severe  disturbances  in  the 
mental  and  physical  health,  but  as  the  habit  is  stopped  at  an 
early  period  of  life,  as  soon  as  the  indecency  of  the  habit  is  ex- 
plained, no  possible  consequences  ever  arise.  We  must  all 
encounter  a  period  in  life  when  there  is  a  conflict  between  the 
passions  and  one's  better  self,  but  the  latter  is  usually  the  victor 
in  the  combat.  It  is  not  an  exaggeration  to  maintain,  that, 
in  the  majority  of  instances,  the  evils  arising  from  masturbation 
practiced  moderately,  and  for  a  short  period  in  youth,  are 
largely  mental,  developed  from  the  loss  of  self-respect  and  the 
sense  of  unmanliness. 

Syphilophobia  is  the  morbid  dread  of  having  contracted 
syphilis.  When  other  venereal  diseases  have,  or  are  supposed 
to  have  been  acquired,  the  mental  suffering  in  some  individuals 
is  equally  intense.  The  anxiety  of  mind  conquers  the  entire 
being.  Sleep,  digestion  and  nutrition  are  in  consequence  im- 
paired, and  the  unending  terror  may  last  a  lifetime  unless 
controlled  by  the  conscientious  physician,  who  is  often  able  by  the 
modern  aids  of  science,  to  make  innocuous  the  indiscretions 
arising  from  venereal  disease.  Often  the  sexual  madness  has 
no  real  foundation;  a  harmless  skin  eruption,  lax,  or  too 
tightly  drawn  testicles,  innocent  pimples  and  the  like  are  apt  to 
be  construed  as  manifestations  of  some  disease  of  the  blood. 

TREATMENT  OF  SEXUAL  NEURASTHENIA — Conjugal  hy- 
giene. Normal  sexual  intercourse  is  the  most  powerful  passion 
of  human  nature  conducive  to  strong  and  vigorous  health. 
When  followed  by  a  feeling  of  well  being,  it  is  healthful  but, 
if  on  the  contrary  it  is  followed  by  depression,  the  act  is  harm- 
ful. Unnatural  methods  of  intercourse  such  as  withdrawal, 
use  of  condoms  and  prolongation  of  the  act  are  especially 
harmful  and  are  often  the  essential  cause  of  a  protracted  siege 
of  sexual  neurasthenia.  It  must  not  be  forgotten  that  the 
health  of  the  offspring  is  largely  dependent  on  the  condition 
of  the  parents  at  the  time  of  the  conception  and  for  this  reason  r 


Y 


48 

the  laws  of  sexual  hygiene  should  be  observed  most  rigorously. 
Spitzka  affirms  that  "  children  begotten  by  a  drunken  father 
have  repeatedly  been  found  to  be  epileptic,  imbecile,  deaf, 
mute  or  insane."  Undue  repetition  of  the  sexual  act  is  re- 
pugnant to  the  moral  sense  and  is  certain  to  be  followed  by 
evil  consequences.  Sexual  intercourse  is  intended  for  the  pur- 
pose of  reproduction  and  the  prevention  of  conception  is  an 
injustice  to  society  and  results  in  injury  to  both  sexes. 

The  treatment  of  seminal  emissions  is  geng£a4ty  a  simple 
matter  when  conducted  by  the  physician.  Aside  from  local 
^nTa^^es~the  building  up  of  the  nervous,  system  is  an  absolute 
essential.  To  arrest  the  emissions  entirely  in  a  continent  unmar- 
ried man  is  an  impossibility.  What  can  really  be  achieved 
is  this,  to  allow  the  emissions  to  continue  without  any  detri- 
ment to  health.  Marriage,  while  offering  immunity  in  the 
majority  of  instances,  is  not  invariably  productive  of  such 
results,  for  there  are  many  married  men  who  continue  to  have 
emissions.  This  is  of  course  usually  unnatural  and  often 
indicates  that  the  strength  of  the  organs  is  imperfect,  or 
because  no  real  pleasure  is  derived  from  the  act  or  because 
there  still  remain  traces  of  former  sexual  troubles.  Before 
emissions  can  be  controlled,  sexual  excitement  and  masturba- 
tion must  be  avoided.  The  diet  should  be  non-stimulating. 
Spices,  alcoholic  drinks,  strong  coffee  and  tea  must  not  be~,  \/ 
used.  Before  retiring  very  little  fluid  or  food  should  be 
taken.  Sleep  should  not  be  prolonged  and  early  rising 
is  important.  The  patients  should  never  lie  on  the  back  and 
the  covering  should  be  light  and  the  bed  hard.  When  patients 
awake  in  the  morning  they  should  at  once  empty  the  bladder. 

The  treatment  of  sexual^neurgsthenia  in  general,  means 
the  correction  of  general  nerve  depression.  Aside  from  local  / 
treatment,  which  may  be  necessary  when  strictures  or  old 
discharges  complicate  the  trouble  or  when  a  tight  prepuce 
exists  or  rectal  irritation  from  piles  or  retained  fecal  matter, 
the  essential  object  always,  is  the  relief  of  nerve  depression  on 
which  the  sexual  disorders  are  dependent.  Charlatans  often 
aggravate  the  sexual  weakness  and  irritability  by  employing 
drugs  and  different  kinds  of  apparatus  which  temporarily 


49 

stimulate  the  debilitated  organs,  leaving  them  in  a  worse  con- 
dition than  ever  before.  In  no  other  disease  is  meddlesome 
treatment  so  disastrous  as  in  sexual  debility,  and  many  individ- 
uals have  been /permanently  injured  by  such  measures.  There 
are  no  specific  drugs  in  the  treatment  of  sexual  neurasthenia. 
Even  moral  treatment,  so  often  vaunted  by  medical  writers,  is  of 
little  avail,  and  while  the  mind  frequently  operates  to  the  dis- 
advantage of  the  sexual  apparatus,  there  is  no  affection  which 
is  less  amenable  to  moral  treatment  than  sexual  neurasthenia. 
Patients  see  no  results  in  expectancy.  They  want  results  and 
the  results  which  they  are  so  eager  to  obtain  can  only  be 
achieved  by  a  correct  toning  of  the  nervous  system. 


WORKS  OF  DR.  ALBERT  ABRAMS 

A  Manual  of  Clinical  Diagnosis 

THIRD  EDITION,  REVISED  AND  ENLARGED. 
ILLUSTRATED. 

Price,  $2. 


The  Occidental  Medical  Times — This  book  contains  a  vast  amount  of 
information ;  it  is,  in  fact,  a  small  encyclopedia  of  diagnosis.  In  its 
present  improved  and  enlarged  form,  it  will  undoubtedly  meet  with  a 
universal  and  well  deserved  popularity. 


Transactions  of  the  Antiseptic  Club 

By  the  same  author, 
ILLUSTRATED. 

IB  one  octavo  volume,  illustrated  by  pen  and  ink  sketches  especially  de- 
signed by  Moss,   Keeler  and  Tiers,   artistically  and  substantially 

bound  in  Antiseptic  Dressing $1.75 

Presentation  Edition.     First  impressions,  large  paper,  extra  quality,  Gilt 
top.    Uncut  Edges.     Half  Vellum  Cloth,  limited  to  subscriptions 

received  and  numbered $2.75 

3d  Edition,  Cloth,  Now  Ready  at  tbo  Popular  Prices.  Postpaid $1.00 

New  York  : 
E.  B.  Treat,  Publisher,  5  Cooper  Union . 

Presi  Comments : 

Southern  California  Practitioner ,  Los  Angeles,  Ca/.—-"We  will  not 
repeat  the  jokes  here,  for  we  hope  our  readers  will  purchase  the  book 
and  enjoy  it  for  themselves.  It  is  full  of  fun  and  satire,  and  yet  under  it 
all  there  is  enough  of  truth  to  be  food  for  thought.  There  is  plenty  of 
ridicule,  and  many  pet  theories  receive  vigorous  left-handed  compli- 
ments. It  is  an  appropriate  work  for  the  office  table  ;  patients  will  enjoy 
it  as  well  as  the  profession.  The  illustrations  are  pat.  It  is  an  excellent 
prescription  for  the  medical  blues." 

Medical  Journal*  Brooklyn,  N.  K— "  Is  is  without  doubt  the  best 
medical  satire  of  the  day." 

The  American  Practitioner  and  News. — "This  volume  supplies  one 
of  the  finest  funds  of  wit  and  humor  of  a  medical  kind,  that  has  yet 
been  given  to  the  public." 

Pacific  Druggist  and  Physician. — "Not  since  the  days  of  Dean 
Swift  have  keener  shafts  of  satire  been  launched  at  the  foibles  of  men 
than  are  hurled  good  naturedly  by  the  well  known  author  of  this  book, 
at  the  weaknesses  of  the  medical  guild." 

Dominion  Medical  Monthly,  Toronto,  Canada.  —  "For  genuine 
amusement  and  fun  this  book  is  one  of  the  best  we  have  ever  had  the 
privilege  of  reading." 


WORKS  OF   DR.  ALBERT  ABRAMS 

Consumption 

ITS  NATURE,  CAUSES,  PREVENTION  AND  CURE. 

By  the  same  author. 

San  Francisco, 
WM.  DOXRY. 

Price,  50  Cents. 

A  little  volume  dedicated  to  all  those  who  are  liable  to  or  suffer  from 
Consumption,  with  the  hope  that  it  will  rescue  the  former  and  help  the 
latter  to  recover. 


A  Synopsis  of  Morbid  Renal 
Secretions 

By  the  same  author. 

A  Practical  Guide   for  Physicians  and  Students  in  the  chemic  and 
microscopic  examination  of  urine. 


Scattered  Leaves 
from   a  Physician's  Diary 

Published  by 

THE  FORTNIGHTLY  PRESS  Co., 
St.  Louis  Mo.  ,1900. 

Pness  Comments  : 

The  Medical  Standard,  Chicago. — "  The  readers  of  the  STANDARD 
are  well  acquainted  with  DR.  ABRAMS'  brilliant  scientific  work,  but  in 
order  to  appreciate  something  of  his  remarkable  versatility,  they  should 
read  this  book  of  delightful  sketches.  Here  he  brings  to  bear  the  side 
lights  of  his  humor  upon  the  foibles  and  weaknesses  of  the  ultra-scientific 
and  makes  a  laughable,  if  somewhat  tragic,  picture  of  the  absurdities  of 
quackery  and  its  congeners.  His  stories  are  bright  and  brainy,  brimming 
full  of  scintillating  wit  that  is  sharpened  by  good  common  sense.  His 
style  is  perfection.  DR.  ABRAMS  attacks  the  shams  with  a  humor  of  the 
practical  kind  that  stands  for  straightforward  honesty.  Every  physician 
who  has  a  sense  of  humor  should  buy  this  book  aud  those  who  are  with- 
out it  should  use  it  as  a  text  book. 

The  San  Francisco  Bulletin. — The  short  stories  contained  in  this 
little  book  are  among  the  best  that  have  been  published  in  a  long  time. 


WORKS   OF   DR.   ALBERT  ABRAMS 

Diseases  of  the  Heart 

A  PRACTICAL  MANUAI,  FOR  PHYSICIANS  AND  STUDENTS 

Price  $1.00 

G.  P.  BNGLEHARD  &  COMPANY,  PUBLISHERS, 
Chicago,  111.,  1900. 

Medical  Standard,  Chicago. — In  this  book  the  author  discusses  the 
subject  of  diseases  of  the  heart  entirely  from  a  practical  aspect.  His 
most  noteworthy  researches  in  methods  of  diagnosis  are  here  recorded 
for  the  first  time  in  collected  form,  and  the  latest  and  most  practical 
methods  of  treatment  given  in  detail. 

It  is  believed  no  other  book  yet  published  is  so  well  fitted  to  become 
the  leading  practical  manual  upon  this  subject.  Dr.  Abrams  is  one  of 
the  most  delightful  writers  now  contributing  to  medical  literature  and 
writes  with  a  clearness  and  logical  continuity  that  gives  a  peculiar  charm 
to  his  work,  which  is  at  the  same  time  of  the  highest  scientific  value. 


Diseases  of  the  Lungs  and  Pleurae 

A  PRACTICAL,  MANUAI,  FOR  PHYSICIANS  AND  STUDENTS. 

Will  be  Published  Shortly  by 


THE  FORTNIGHTLY  PRESS  COMPANY 
St.  I^ouis.  Mo. 


RETURN  TO  the  circulation  desk  of  any 
University  of  California  Library 

or  to  the 

NORTHERN  REGIONAL  LIBRARY  FACILITY 
Bldg.  400,  Richmond  Field  Station 
University  of  California 
Richmond,  CA  94804-4698 

ALL  BOOKS  MAY  BE  RECALLED  AFTER  7  DAYS 

•  2-month  loans  may  be  renewed  by  calling 
(510)642-6753 

•  1-year  loans  may  be  recharged  by  bringing 
books  to  NRLF 

•  Renewals  and  recharges  may  be  made  4 
days  prior  to  due  date. 

DUE  AS  STAMPED  BELOW 


AUG  3  0  2000 


- 


OCT282000 


ELEY 

®$ 


12,000(11/95) 


ft 


YC   14847 


\1\ 


